Hemorragia alveolar difusa asociada a vasculitis ANCA positiva, manejo con plasmaféresis. Reporte de un caso
Palabras clave:
vasculitis, plasmaféresis, síndrome de dificultad respiratoria del adulto
Resumen
Presentamos el caso de una paciente femenina de 43 años con vasculitis tipo ANCA con severo compromiso pulmonar por desarrollo de hemorragia alveolar difusa (HAD) e insuficiencia respiratoria. Debido al rápido deterioro clínico y pobre respuesta a inmunosupresores (ciclofosfamida y metilprednisolona) se le practicó plasmaféresis resultando en rápida mejoría, permitiendo la liberación en la ventilación mecánica y mejoría radiológica. En la actualidad se puede sugerir esta terapia en pacientes con diagnóstico de vasculitis tipo ANCA con compromiso pulmonary severo.Citas
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VIII. Aasarod K, Iversen BM, Hammerstrom J, Bostad L, Jorstad S. Clinical outcome of patients with Wegener’s granulomatosis treated with plasma exchange. Blood Purif. 2002; 20(2):167-173.
IX. Klemmer PJ, Chalermskulrat W, Reif MS, Hogan SL, Henke DC, Falk RJ. Plasmapheresis therapy for diffuse alveolar hemorrhage in patients with small vessel vasculitis. Am J Kidney Dis. 2003; 42(6):1149-1153.
X. Frasca GM, Soverini ML, Falaschini A, Tampieri E, Vangelista A, Stefoni S. Plasma exchange treatment improves prognosis of antineutrophil cytoplasmic antibody-associated crescentic glomerulonephritis: a case-control study in 26 patients from a single center. Ther Apher Dial. 2003; 7(6):540-546.
XI. Jayne DR, Gaskin G, Rasmussen N, Abramowicz D, Ferrario F, Guillevin L, et al.; European Vasculitis Study Group. Randomized trial of plasma exchange or high-dosage methylprednisolone as adjunctive therapy for severe renal vasculitis. J Am Soc Nephrol 2007; 18:2180-8.
XII. Booth AD, Almond MK, Burns A, et al. Pan-Thames Renal Research Group. Outcome of ANCAassociated renal vasculitis: A 5 years retrospective study. Am J Kidney Dis 2003; 41:776-84.
XIII. Falk RJ, Nachman PH, Hogan SL, Jennette JC. ANCA glomerulonephritis and vasculitis: A Chapel Hill perspective. Semin Nephrol 2000; 20:233-243.
XIV. Dhaun N, Saunders A, Bellamy CO et al. Benefits of an expanded use of plasma exchange foranti-neutrophil cytoplasmic antibody-associated vasculitis within a dedicated clinical service.BMC Musculoskelet Disord. 2015 Nov 9; 16:343. doi: 10.1186/s12891-015-0796-7.
XV. Walters G. Role of therapeutic plasmapheresis in ANCA.associated vasculitis.Pediatr Nephrol. 2016 Feb; 31(2):217-25.
XVI. Szpirt WM. Plasma exchange in antineutrophil cytoplasmic antibody-associated vasculitis-a 25 years perspective. Nephrol Dial Transplant. 2015 Apr; 30Suppl 1:i146-9.
XVII. Cartin-Ceba R, Diaz-Caballero L, Algadi MO et al. Diffuse alveolar hemorrhage secondary to ANCAassociated vasculitis: Predictors of respiratory failure and clinical outcomes. Arthritis Rheumatol 2015; Dec 29. doi: 10.1002/art.39562
XVIII. Nguyen T, Martin MK, Indrikovs AJ, Plasmapheresis for Diffuse Alveolar Hemorrhage in a Patient With Wegener’s Granulomatosis: Case Report and Review of the Literature J Clin Apheresis 2005; 20:230-234.
II. Cotch MF, Hoffman GS, Yerg DE, Kaufman GI, Targonski P. Estimates of the five-year period prevalence, annual mortality, and geographic disease distribution from population-based data sources. Arthritis Rheum. 1996; 39(1):87-92.
III. Travis WD, Colby TV, Lombard C, Carpenter HA. A clinic-pathologic study of 34 cases of diffuse pulmonary hemorrhage with lung biopsy confirmation. Am J Surg Pathol. 1990; 14(12):1112-1125.
IV. Boomsma MM, Stegeman CA , van der Leij MJ , et al. Prediction of relapses in Wegener’s granulomatosis by measurement of antineutrophil cytoplasmic antibody levels: a prospective study. Arthritis Rheum. 2000; 43 (9):2025-2033.
V. Walton EW. Giant-cell granuloma of the respiratory tract (Wegener’s granulomatosis). Br Med J. 1958; 2(5091):265-270.
VI. Fauci AS, Wolff SM. Wegener’s granulomatosis: studies in eighteen patients and a review of the literature. Medicine (Baltimore). 1973; 52(6):535-561.
VII. Booth AD, Almond MK, Burns A, et al. Outcome of ANCA-associated renal vasculitis: a 5-year retrospective study. Am J Kidney Dis. 2003; 41(4):776-784.
VIII. Aasarod K, Iversen BM, Hammerstrom J, Bostad L, Jorstad S. Clinical outcome of patients with Wegener’s granulomatosis treated with plasma exchange. Blood Purif. 2002; 20(2):167-173.
IX. Klemmer PJ, Chalermskulrat W, Reif MS, Hogan SL, Henke DC, Falk RJ. Plasmapheresis therapy for diffuse alveolar hemorrhage in patients with small vessel vasculitis. Am J Kidney Dis. 2003; 42(6):1149-1153.
X. Frasca GM, Soverini ML, Falaschini A, Tampieri E, Vangelista A, Stefoni S. Plasma exchange treatment improves prognosis of antineutrophil cytoplasmic antibody-associated crescentic glomerulonephritis: a case-control study in 26 patients from a single center. Ther Apher Dial. 2003; 7(6):540-546.
XI. Jayne DR, Gaskin G, Rasmussen N, Abramowicz D, Ferrario F, Guillevin L, et al.; European Vasculitis Study Group. Randomized trial of plasma exchange or high-dosage methylprednisolone as adjunctive therapy for severe renal vasculitis. J Am Soc Nephrol 2007; 18:2180-8.
XII. Booth AD, Almond MK, Burns A, et al. Pan-Thames Renal Research Group. Outcome of ANCAassociated renal vasculitis: A 5 years retrospective study. Am J Kidney Dis 2003; 41:776-84.
XIII. Falk RJ, Nachman PH, Hogan SL, Jennette JC. ANCA glomerulonephritis and vasculitis: A Chapel Hill perspective. Semin Nephrol 2000; 20:233-243.
XIV. Dhaun N, Saunders A, Bellamy CO et al. Benefits of an expanded use of plasma exchange foranti-neutrophil cytoplasmic antibody-associated vasculitis within a dedicated clinical service.BMC Musculoskelet Disord. 2015 Nov 9; 16:343. doi: 10.1186/s12891-015-0796-7.
XV. Walters G. Role of therapeutic plasmapheresis in ANCA.associated vasculitis.Pediatr Nephrol. 2016 Feb; 31(2):217-25.
XVI. Szpirt WM. Plasma exchange in antineutrophil cytoplasmic antibody-associated vasculitis-a 25 years perspective. Nephrol Dial Transplant. 2015 Apr; 30Suppl 1:i146-9.
XVII. Cartin-Ceba R, Diaz-Caballero L, Algadi MO et al. Diffuse alveolar hemorrhage secondary to ANCAassociated vasculitis: Predictors of respiratory failure and clinical outcomes. Arthritis Rheumatol 2015; Dec 29. doi: 10.1002/art.39562
XVIII. Nguyen T, Martin MK, Indrikovs AJ, Plasmapheresis for Diffuse Alveolar Hemorrhage in a Patient With Wegener’s Granulomatosis: Case Report and Review of the Literature J Clin Apheresis 2005; 20:230-234.
Publicado
2015-12-01
Cómo citar
1.
Herrera Escandón Álvaro. Hemorragia alveolar difusa asociada a vasculitis ANCA positiva, manejo con plasmaféresis. Reporte de un caso. Rev. Argent. Reumatol. [Internet]. 1 de diciembre de 2015 [citado 25 de abril de 2024];26(4):42 -44. Disponible en: https://ojs.reumatologia.org.ar/index.php/revistaSAR/article/view/644
Sección
Caso Clínico
Derechos de autor 2015 A nombre de los autores. Derechos de reproducción: Sociedad Argentina de Reumatología
Esta obra está bajo licencia internacional Creative Commons Reconocimiento-NoComercial-SinObrasDerivadas 4.0.
