Plasmapheresis for diffuse alveolar hemorrhage in a patient with Wegener's granulomatosis: Case report and review of the literature

We present a case of a 20‐year‐old male with Wegener's Granulomatosis involving the upper respiratory tract, lungs, and kidneys. In his fourth hospital admission, the patient presented with diffuse alveolar hemorrhage and poor pulmonary function: FiO 2 of 100% and PEEP of 17cm H 2 O on intubation. Due to a fast clinical deterioration while receiving drug therapy (cyclophosphamide and methylprednisolone), we performed nine daily 1‐volume therapeutic plasma exchanges (TPE) using 5% albumin as replacement fluid. TPE resulted in a decrease in cytoplasmic anti‐neutrophil cytoplasm antibodies (c‐ANCA) titer from 1:1,024 to 1:16. On the ninth day of plasmapheresis, his pulmonary status was markedly improved with FiO 2 of 60% and PEEP of 8 cm H 2 O. The patient was later extubated and discharged home in stable condition. Wegener's Granulomatosis with pulmonary hemorrhage is not included in the current guidelines for therapeutic apheresis; therefore, we report this case and, if warranted, propose this condition to be included in the guidelines. J Clin Apheresis 2005. © 2005 Wiley‐Liss, Inc.