Plasmapheresis in fulminating acute inflammatory polyradiculoneuropathy: The first experience at Siriraj Hospital.

ABSTRACT

A first experience of plasmapheresis in treatment of fulminating acute inflammatory polyradiculoneuropathy at Siriraj Hospital was reported with an excellent outcome. A 62 year old man had progressive motor weakness of all extremities and progressed to involve bulbar muscles and respiratory muscles within 24 hours. He was intubated and needed assisted ventilation since the admission. His motor power of all limbs showed a flaccid improvement after the total removal of 5,200 ml. He was discharged home after six weeks of hospitalization and total days of ventilation was twenty four days. He had a stormy clinical course in the intensive care unit with severe chest infection of mixed organisms (Klepsiella and Pseudomonas). His motor power regained to grade 4/5 MRC grading on discharging day with healed tracheostomy scar. Rationals for using plasmapheresis in this condition were discussed in detail as well as its usage in other illnesses.