Limited plasmapheresis in rheumatoid vasculitis during opportunistic infection:For the substitution of immunosuppressive therapy

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A 59-year-old man was admitted to the hospital because of polyarthralgia. After admission interstitial pneumonitis and pleuritis developed and a diagnosis of rheumatoid vasculitis was made. Treatment with steroids including pulse therapy was initiated and all symptoms went into remission. Three months after, cough, sputa and dyspnea developed. Invasive pulmonary aspergillosis was diagnosed based upon the findings of the culture of sputa and chest roentogenogram. Amphotericin B could not be used because of adverse reaction. For the treatment of opportunistic infection, the dosage of steroids had to be decreased, but the serum immune complex level went up and polyarthralgia reappeared, suggesting a relapse of rheumatoid vasculitis. Double filtration plasmapheresis (DFPP) was then started for the treatment of rheumatoid vasculitis. The clinical symptoms of the disease improved as the serum immune complex level decreased, while invasive aspergillosis turned to aspergilloma by the treatment of aspergillus and improvement of host immunity. After a series of 18 trials of DFPP, it could be discontinued and immunosupressants were administered instead.Since DFPP does not affect normal immunity compared with immunosuppressants, although this method is costly, a limited period of DFPP trials is recommended as the treatment for rheumatoid vasculitis during the period of opportunistic infection.
日本臨床免疫学会の論文