A Case Report of Double Filtration Plasmapheresis in an Acute Episode of Multiple Sclerosis

Double filtration plasmapheresis (DFPP) is an emerging semi-selective apheretic method for treating immuno-mediated neurological diseases. Here we report the first case of steroid-refractory relapsed multiple sclerosis (MS) on Fingolimod (FTY), treated effectively by this technique, in a 37-year-old woman. This condition is thought to be caused by soluble inflammatory species, but its demyelinating pattern is unknown; moreover, despite megadoses of intravenous 6-methyl prednisolone, it induces severe neurological deterioration, but dramatically responded to DFPP in our patient. The clinical improvement was driven by a strong DFPP-induced anti-inflammatory effect, with significant reduction of C3/C4 components, total gamma globulin concentrations (IgG), and gamma-fibrinogen (FGG), resulting in a brain pseudoatrophy phenomenon. Our findings are: first, the steroid-refractory relapsed MS on FTY, however serious, can be treated with DFPP; second, given the good clinical improvement due to the DFPP-induced neuroinflammatory components removal, this clinical condition can be associated with a Lucchinetti pattern II of demyelination.

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Successful treatment of steroid-resistant anti-aquaporin 4 antibody-positive optic neuritis with double-filtration plasmapheresis: a case report

Nihon Toseki Igakkai Zasshi ◽

10.4009/jsdt.51.379 ◽

2018 ◽

Vol 51 (6) ◽

pp. 379-385

Author(s):

Kei Fukuda-Hihara ◽

Masayuki Iyoda ◽

Tomohiro Saito ◽

Noriko Arai-Nunota ◽

Yukihiro Wada ◽

...

Keyword(s):

Case Report ◽

Optic Neuritis ◽

Successful Treatment ◽

Aquaporin 4 ◽

Steroid Resistant ◽

Double Filtration Plasmapheresis ◽

Double Filtration ◽

Aquaporin 4 Antibody

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Double filtration plasmapheresis in an ABO-incompatible renal transplantation: a case report

Transplantation Proceedings ◽

10.1016/s0041-1345(02)03856-3 ◽

2003 ◽

Vol 35 (1) ◽

pp. 227-229 ◽

Cited By ~ 2

Author(s):

H Kawamura ◽

M Matsumura ◽

Y Kishi ◽

K Fujikawa ◽

K Uchiyama ◽

...

Keyword(s):

Case Report ◽

Renal Transplantation ◽

Double Filtration Plasmapheresis ◽

Double Filtration

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Resistant oral mucosal lesions in pemphigus vulgaris responsive to double filtration plasmapheresis: First case report from Turkey

Transfusion and Apheresis Science ◽

10.1016/j.transci.2013.01.008 ◽

2013 ◽

Vol 48 (2) ◽

pp. 273-275 ◽

Cited By ~ 4

Author(s):

E. Şavk ◽

M. Uslu ◽

I. Yavaşoğlu ◽

G. Kadıköylü ◽

N. Şendur ◽

...

Keyword(s):

Case Report ◽

Pemphigus Vulgaris ◽

Double Filtration Plasmapheresis ◽

First Case ◽

Oral Mucosal Lesions ◽

Mucosal Lesions ◽

Double Filtration

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A Case Report of Double-Filtration Plasmapheresis for the Resolution of Refractory Chronic Urticaria

Therapeutic Apheresis and Dialysis ◽

10.1111/j.1744-9987.2008.00642.x ◽

2008 ◽

Vol 12 (6) ◽

pp. 505-508 ◽

Cited By ~ 10

Author(s):

Xinxin Jiang ◽

Mingxi Lu ◽

Yingjuan Ying ◽

Jian Feng ◽

Youxin Ye

Keyword(s):

Case Report ◽

Chronic Urticaria ◽

Double Filtration Plasmapheresis ◽

Double Filtration

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A Case Report of Double-Filtration Plasmapheresis for the Treatment of Age-related Macular Degeneration

Therapeutic Apheresis and Dialysis ◽

10.1111/j.1744-9987.2008.00641.x ◽

2008 ◽

Vol 12 (6) ◽

pp. 500-504 ◽

Cited By ~ 7

Author(s):

Jiann-Horng Yeh ◽

Cheng-Kuo Cheng ◽

Hou-Chang Chiu

Keyword(s):

Case Report ◽

Macular Degeneration ◽

Age Related Macular Degeneration ◽

Double Filtration Plasmapheresis ◽

Age Related ◽

Double Filtration

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A Case Report of Efficiency of Double Filtration Plasmapheresis in Treatment of Goodpasture's Syndrome

Therapeutic Apheresis and Dialysis ◽

10.1111/j.1744-9987.2009.00687.x ◽

2009 ◽

Vol 13 (4) ◽

pp. 373-377 ◽

Cited By ~ 9

Author(s):

Nagasu Hajime ◽

Abe Michiko ◽

Kuwabara Atsunori ◽

Kawai Tatsuo ◽

Nishi Yuko ◽

...

Keyword(s):

Case Report ◽

Goodpasture's Syndrome ◽

Goodpasture’S Syndrome ◽

Double Filtration Plasmapheresis ◽

Double Filtration

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Myasthenia Gravis with Anti-Muscle-Specific Tyrosine Kinase Antibody during Pregnancy and Risk of Neonatal Myasthenia Gravis: A Case Report and Review of the Literature

Case Reports in Neurology ◽

10.1159/000506189 ◽

2020 ◽

Vol 12 (1) ◽

pp. 114-120

Author(s):

Ken-ichi Inoue ◽

Jun Tsugawa ◽

Jiro Fukae ◽

Kosuke Fukuhara ◽

Hiroyasu Kawano ◽

...

Keyword(s):

Case Report ◽

Tyrosine Kinase ◽

Myasthenia Gravis ◽

Upper Limb ◽

High Probability ◽

Oral Steroid ◽

Review Of The Literature ◽

Limb Weakness ◽

Double Filtration Plasmapheresis ◽

Double Filtration

A 31-year-old woman presented with a nasal voice, dysarthria, and upper limb weakness during her first pregnancy. Soon after delivery of her first baby, her symptoms disappeared. At the age of 34 years, during her second pregnancy, her nasal voice re-appeared. After delivery of the second baby, her nasal voice worsened, and bilateral eyelid ptosis and easy fatigability were also evident. She was referred to our hospital. Because of her myasthenic symptoms and anti-muscle-specific tyrosine kinase (MuSK) antibody (Ab)-positive status, she was diagnosed as having myasthenia gravis (MG). Her symptoms were worse than those in her first pregnancy. She was treated with oral steroid and double filtration plasmapheresis. After initiation of treatment, her myasthenic symptoms improved completely. In addition, her baby developed transient neonatal MG (TNMG) on the fourth day after birth and then gradually recovered over 30 days. It should be noted that symptoms of patients with anti-MuSK Ab-positive MG (MuSK-MG) can deteriorate during pregnancy, and the babies delivered of patients with MuSK-MG have a high probability of developing TNMG.

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