Successful Use of Plasma Exchange in the Treatment of Corticosteroid-Refractory Eosinophilic Granulomatosis with Polyangiitis Associated with Gastrointestinal Manifestations

Abstract

We describe the case of a 33-year-old woman having corticosteroid-refractory eosinophilic granulomatosis with polyangiitis (EGPA) who presented with abdominal pain and responded dramatically to plasma exchange. Eosinophilia, asthma history, neuropathy, pulmonary infiltrates, and paranasal sinus abnormalities confirmed the diagnosis of EGPA. Treatment was initiated with 1 g/day of methylprednisolone pulse therapy for 3 days followed by 60 mg/day of intravenous prednisolone without relieving abdominal pain. Then, plasma exchange was performed thrice. Abdominal pain disappeared after the first plasma exchange. Indication of plasma exchange for EGPA remains controversial; however, it may represent a valid option in cases with gastrointestinal involvement.

Removal of Endotoxins and Cytokines by Plasmapheresis Filtration with Plasma Exchange Therapy (TPE) Could Benefit Patients with Covid-19 in Critical Condition

“…TPE includes albumin infusion for the restoration of plasma volume and protein depletion, followed by the Plasmapheresis [26]. The anti-inflammatory effect of extracorporeal blood purification as Plasmapheresis is very well known and used in different morbid conditions like liver failure, progressive immune diseases as Corticosteroid-Refractory Eosinophilic Granulomatosis [28], Guillain-Barré Syndrome in Children [29,12] or drug-resistant bronchial asthma [30]. The positive results of the CHF with TPE in patients with severe inflammation with a high level of cytokines were published in 2015 [31].…”