scholarly journals Exogenous insulin antibody syndrome treated with plasma exchange after an incomplete response to immunosuppressive therapy

2021 ◽  
Author(s):  
Yuan Zhuang ◽  
Xudong Wei ◽  
Yang Yu ◽  
Deqing Wang
Keyword(s):  
Plasma Exchange ◽  
Immunosuppressive Therapy ◽  
Insulin Antibody ◽  
Exogenous Insulin ◽  
Incomplete Response

Therapeutic plasma exchange for exogenous insulin antibody syndrome in combined variable immunodeficiency: a case report

2020 ◽  
Vol 35 (2) ◽  
pp. 128-130 ◽  
Author(s):  
Daniel J. Robbins ◽  
Natalie E. Taylor ◽  
Damodaran Narayanan ◽  
Aaron S. Hess ◽  
William N. Rose
Keyword(s):  
Case Report ◽  
Plasma Exchange ◽  
Therapeutic Plasma Exchange ◽  
Insulin Antibody ◽  
Exogenous Insulin

scholarly journals MPO-ANCA-Positive Anti-glomerular Basement Membrane Antibody Disease Successfully Treated by Plasma Exchange and Immunosuppressive Therapy

Renal Failure ◽  
2011 ◽  
Vol 33 (6) ◽  
pp. 626-631 ◽  
Author(s):  
Taichi Murakami ◽  
Kojiro Nagai ◽  
Motokazu Matsuura ◽  
Naoki Kondo ◽  
Seiji Kishi ◽  
...  
Keyword(s):  
Basement Membrane ◽  
Plasma Exchange ◽  
Immunosuppressive Therapy ◽  
Glomerular Basement Membrane

Autoimmune Haemolytic Anaemia Treated with Multiple Transfusions, Immunosuppressive Therapy, Plasma Exchange, and Desferrioxamine

1984 ◽  
Vol 73 (1) ◽  
pp. 145-148 ◽  
Author(s):  
O. ANDERSEN ◽  
E. TAANING ◽  
J. ROSENKVIST ◽  
N. E. MØLLER ◽  
H. H. MOGENSEN
Keyword(s):  
Plasma Exchange ◽  
Immunosuppressive Therapy ◽  
Haemolytic Anaemia ◽  
Autoimmune Haemolytic Anaemia

scholarly journals Acquired hemophilia A successfully treated with immunosuppressive therapy and plasma exchange

2003 ◽  
Vol 92 (8) ◽  
pp. 1537-1539
Author(s):  
Dai Maruyama ◽  
Kaichi Nishiwaki ◽  
Koji Sano ◽  
Shuichi Masuoka ◽  
Hiroki Yokoyama ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Immunosuppressive Therapy ◽  
Hemophilia A ◽  
Acquired Hemophilia A ◽  
Acquired Hemophilia

scholarly journals Immunotherapy-Related Autoimmune Diabetes Mellitus and Exogenous Insulin Antibody Syndrome in a Patient With Metastatic Oral Squamous Cell Carcinoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A387-A388
Author(s):  
Maimoona Bahlol ◽  
Yufei Dai
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Insulin Lispro ◽  
Autoimmune Diabetes ◽  
Venous Blood ◽  
Insulin Level ◽  
Insulin Antibody ◽  
Diabetic Patients ◽  
Exogenous Insulin ◽  
Fasting Hypoglycemia

Abstract Introduction: Exogenous insulin antibody syndrome (EIAS) is a rare condition characterized by wide glycemic excursions and recurrent hypoglycemia in the presence of high insulin antibody titers. It has been described in diabetic patients treated with exogenous insulin. Programmed death ligand 1 (PD-L1) inhibitors are known to cause autoimmune diabetes mellitus, but PD-L1-related EIAS has not yet been reported to our best knowledge. Case Description: A 63 years old Caucasian man with history of recurrent oral squamous cell cancer presented to emergency room with polyuria, polydipsia, nausea, and vomiting 3 months after initiation of immunotherapy (Durvalumab and cetuximab). He had no prior history of diabetes mellitus or hypoglycemia. He was admitted to hospital for management of diabetic ketoacidosis (Anion gap of 24 mEq/L, venous blood glucose of 805 mg/dL, Venous PH of 7.12, large urine ketone, A1C of 8.9%). After a brief hospital stay, the patient was discharged home on insulin glargine and metformin. His immunotherapy was resumed after hospital discharge. When the patient was seen by Endocrinologist in the clinic, metformin was discontinued and prandial insulin lispro was added. This basal-bolus insulin regimen improved his glycemic control initially. However, without significant changes in his lifestyle or medical condition, he developed worsening postprandial hyperglycemia and recurrent fasting hypoglycemia. Up-titration of his mealtime insulin did not lower postprandial hyperglycemia but possibly worsened fasting hypoglycemia. EIAS was suspected after reviewing his continuous glucose monitoring data. Further work up at this point revealed mildly elevated glutamic acid decarboxylase antibodies (5.9 units/mL, normal range 0.5 - 5.0) and markedly elevated insulin antibody level (77.0 µU/mL, normal range <5). His blood C-peptide was undetectable when his venous blood glucose was 252 mg/dl. In addition, his total insulin level (198 uU/mL) was much higher than his free insulin level (38 uU/mL) following an insulin lispro injection. The patient was diagnosed with EIAS. Switching insulin lispro to insulin aspart while he was on a different immunotherapy medication (Pembrolizumab) immediately reduced his average blood glucose and reduced his total daily insulin dosage by more than 50%. This improvement in glycemic control with insulin aspart only lasted for about 1 week. Unfortunately, the patient’s squamous cancer progressed on immunotherapy. He was referred to hospice care and passed away. Conclusion: Evaluation for EIAS would be reasonable in insulin-treated diabetic patients who develop wide glucose excursions and unexplained fasting hypoglycemia while on immunotherapy.

scholarly journals A Case of Goodpasture's Syndrome with Recurrent Alveolar Hemorrhage Successfully Treated with Repeated Immunosuppressive Therapy and Plasma Exchange

2019 ◽  
Vol 69 (1) ◽  
pp. 37-41
Author(s):  
Koichi Kishida ◽  
Masafumi Kanamoto ◽  
Aya Kamiyama ◽  
Hiroaki Matsuoka ◽  
Masaru Tobe ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Immunosuppressive Therapy ◽  
Alveolar Hemorrhage ◽  
Goodpasture's Syndrome ◽  
Goodpasture’S Syndrome

Successful treatment of anti-MDA5 antibody-positive refractory interstitial lung disease with plasma exchange therapy

Rheumatology ◽  
2019 ◽  
Vol 59 (4) ◽  
pp. 767-771 ◽  
Author(s):  
Yoshiyuki Abe ◽  
Makio Kusaoi ◽  
Kurisu Tada ◽  
Ken Yamaji ◽  
Naoto Tamura
Keyword(s):  
Survival Rate ◽  
Interstitial Lung Disease ◽  
Adverse Events ◽  
Lung Disease ◽  
Plasma Exchange ◽  
Immunosuppressive Therapy ◽  
Fresh Frozen Plasma ◽  
Fresh Frozen ◽  
Frozen Plasma ◽  
Intensive Immunosuppressive Therapy

Abstract Objectives We examined the effectiveness of plasma exchange (PE) therapy to reduce the mortality of rapidly progressive interstitial lung disease (RP-ILD) in patients positive for anti-melanoma differentiation-associated gene 5 (MDA5) antibodies. Methods Among 142 patients newly diagnosed with PM/DM or clinically amyopathic DM from 2008 to 2019 at our hospital, 10 were diagnosed with refractory RP-ILD and were positive for anti-MDA5 antibodies. PE was used as an adjunct to standard therapy and consisted of fresh frozen plasma as replacement solution. The primary outcome was non-disease-specific mortality. Results Anti-MDA5 antibodies were detected in 28 patients, of whom 21 were diagnosed with RP-ILD and 10 were refractory to intensive immunosuppressive therapy. Six patients received PE (PE group) and four did not (non-PE group). The 1-year survival rate of the PE group was higher than that of the non-PE group (100% and 25%, respectively, P = 0.033). Regarding adverse events associated with PE, two patients had anaphylactic shock, one had high fever due to fresh frozen plasma allergy and one had a catheter infection. All adverse events resolved with appropriate treatment. Conclusion We evaluated the association between 1-year survival rate and PE for refractory RP-ILD in patients positive for anti-MDA5 antibodies. Intensive immunosuppressive therapy improved the survival rate in RP-ILD patients with anti-MDA5 antibodies, but 20–30% of cases were still fatal. PE could be administered to patients with active infectious disease who were immunocompromised by intensive immunosuppressive therapy. PE may be considered in refractory RP-ILD patients positive for anti-MDA5 antibodies.

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