Protein A immunoadsorption for anti-glomerular basement membrane nephritis.
Heliyon
Anti-glomerular basement membrane (GBM) nephritis is a rare autoimmune disorder characterized by acute and rapidly progressive glomerulonephritis. In this report, we present the case of a 52-year-old woman with anti-GBM nephritis who was treated with Staphylococcus Protein A immunoadsorption in combination with glucocorticoids and cyclophosphamide. After 8 cycles of immunoadsorption, the patient's anti-GBM antibodies decreased from 363 AU/mL to less than 20 AU/mL, accompanied by a dropped immunoglobin G level, although renal impairment persisted. We reviewed the therapeutic options for anti-GBM nephritis and compared plasma exchange, double filtration plasmapheresis, and immunoadsorption with regard to plasma consumption, allergic events, and plasma components loss. Protein A immunoadsorption appears to be a promising treatment modality for anti-GBM nephritis.
10.1016/j.heliyon.2024.e35049
Life-threatening immune checkpoint inhibitor-induced myocarditis and myasthenia gravis overlap syndrome treated with abatacept: a case report.
BMJ case reports
We present here the second documented case of severe immune checkpoint inhibitor-induced myocarditis successfully treated with abatacept. The patient was started on pembrolizumab for stage IIIA malignant melanoma, and after the first dose was admitted for worsening shortness of breath and weakness. Her symptoms were refractory to high-dose steroids and she decompensated rapidly necessitating cardiopulmonary resuscitation and subsequent intubation and mechanical ventilation. Intravenous immunoglobulin and plasmapheresis did not invoke significant improvement, so abatacept was then initiated. She began to show improvement and was eventually discharged to a skilled nursing facility. This case highlights a severe adverse reaction to an immunomodulator class steadily growing in its application. Providers of all specialties should be aware of the side effects and treatment options. Our case demonstrates that continued investigation into the utilisation of CTLA-4 agonists in the treatment of severe adverse reactions like myocarditis caused by pembrolizumab is required.
10.1136/bcr-2021-244334
Guillain-Barré syndrome in a heart transplantation recipient.
Wei Ching-Wen,Liu Chin-Yu,Chang Chung-Yi,Liu Wei-Chun,Cheng Hao-Chun,Tung Heng-Hsin,Chiang Nian-Chen,Chang Hsin-Huei
Journal of the American Association of Nurse Practitioners
ABSTRACT:A rare case of a heart transplantation recipient with Guillain-Barré syndrome occurred, which was associated with peripheral nervous system damage. Based on a review of epidemiological research, the symptom development process, and diagnostic tools, the authors highlight the extreme rarity of this postinfectious immune disease. After diagnosis, plasma exchange and immunoregulatory therapy should be performed because they result in rapid recovery. If there is delayed diagnosis and treatment, there is a high risk of disability or death. When patients experience acute limb paralysis as the main symptom, nurse practitioners (NPs) should focus on the patient's history, particularly with regard to infectious agents. Closely monitoring the patient to detect respiratory failure and the need for early respiratory intervention can help the patient to avoid the severe complication of permanent brain injury. For NPs, performance of early differential diagnosis is important, especially among patients who have immunosuppressive dependence after transplantation.
10.1097/JXX.0000000000000400