Therapeutic plasma exchange for the acute management of the catastrophic antiphospholipid syndrome: ?2-glycoprotein I antibodies as a marker of response to therapy

Objective: Graves disease is the most common cause of thyrotoxicosis. Medical management is the first-line treatment but may be contraindicated or ineffective. In patients with severe, refractory thyrotoxicosis therapeutic plasma exchange (TPE) may be indicated as a bridge to thyroidectomy. Methods: We present 3 cases of thyrotoxicosis refractory to medical management that were successfully treated with TPE and subsequent total thyroidectomy, and provide an analysis of the response to therapy via a change in free thyroxine (fT4) levels throughout their treatment course. Results: The average change in fT4 per liter of fluid exchanged was 0.37 ng/dL (SD = 0.08) and the average percentage change of fT4 after each treatment was 20.7% (SD = 8.28). The mean decrease in fT4 after 4 TPE treatments was 57.4%. All patients successfully underwent total thyroidectomy without complication and were discharged from the hospital. Conclusion: TPE should be considered for thyrotoxic patients with severe hyperthyroidism or thyroid storm refractory to medical management or contraindications to antithyroid drugs who need a bridge to total thyroidectomy. In these cases, TPE was a safe and effective treatment that enabled definitive management with thyroidectomy and may be considered in other patients with severe refractory hyperthyroidism or thyrotoxicosis.

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OP0231 The effect of “triple therapy” with anticoagulation plus corticosteroids plus plasma exchange and/or intravenous immunoglobulins on the mortality of catastrophic antiphospholipid syndrome (CAPS) patients

10.1136/annrheumdis-2017-eular.3412 ◽

2017 ◽

Author(s):

I Rodríguez-Pintό ◽

G Espinosa ◽

D Erkan ◽

Y Shoenfeld ◽

R Cervera ◽

...

Keyword(s):

Plasma Exchange ◽

Triple Therapy ◽

Antiphospholipid Syndrome ◽

Intravenous Immunoglobulins ◽

Catastrophic Antiphospholipid Syndrome

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Plasma Exchange in the Management of Catastrophic Antiphospholipid Syndrome

Case Reports in Critical Care ◽

10.1155/2016/5375080 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Dimitri Titeca-Beauport ◽

Valery Salle ◽

Loay Kontar ◽

Julien Maizel ◽

Gabriel Choukroun

Keyword(s):

Plasma Exchange ◽

Antiphospholipid Syndrome ◽

General Condition ◽

Oxygen Therapy ◽

Single Case ◽

Heparin Therapy ◽

University Teaching ◽

Optimal Timing ◽

Rapid Improvement ◽

Catastrophic Antiphospholipid Syndrome

Objective. Report of a case of catastrophic antiphospholipid syndrome (CAPS) with multiple organ involvement leading to a life-threatening condition despite early combination corticosteroid and heparin therapy. Initiation of plasma exchange led to rapid improvement of the patient’s general condition. Design. Case report. Setting. University teaching hospital medical intensive care unit. Patient. Single case: 52-year-old man hospitalized for catastrophic antiphospholipid syndrome (CAPS) with cardiac, renal, and cutaneous involvement. Despite early methylprednisolone and heparin therapy, the patient’s condition progressively deteriorated, resulting in acute renal failure, right adrenal hemorrhage, and pulmonary involvement, leading to acute respiratory distress on day 6, requiring high-flow nasal cannula oxygen therapy with FiO2 of 1.0. Interventions. Plasma exchange was started on day 6. Endpoints and Main Results. A marked improvement of the patient’s general condition was observed after initiation of plasma exchange, with successful weaning of oxygen therapy and normalization of platelet count, troponin, and serum creatinine within four days. Conclusions. This case illustrates the efficacy of plasma exchange in CAPS and the difficulty for physicians to determine the optimal timing of plasma exchange.

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