Concurrent Extracorporeal Membrane Oxygenation, Plasmapheresis and Continuous Renal Replacement Therapy in a Case of Wegener’s Granulomatosis.

ABSTRACT

Wegener's Granulomatosis is one of the ANCA-associated vasculitis characterized by multifocal vascular necrotizing inflammation and granulomas that commonly present with a pulmonary-renal syndrome. We report a case of 38 year-old female patient who presented with acute respiratory distress syndrome due to diffuse alveolar hemorrhage and multiorgan failure. The patient being in a hemodynamic collapse was aggressively intubated and supported by mechanical ventilation and vasopressor therapy. Despite all effort refractory hypoxemia could not be coped with. Venovenous extracorporeal membrane oxygenation was started through a femoral and jugular vein. Her oxygenation dramatically ameliorated after the beginning of this procedure. 1 gr/day pulse metylprednisolone was administered followed by cyclophosphamide. Concurrent continious renal replacement therapy and plasmapheresis was begun. Her clinical status improved in days giving rise to weaning of the extracorporeal membrane oxygenation by the day twelve. Extracorporeal membrane oxygenation is reported to be a successful mode of therapy in various cases in the literature including diffuse alveolar hemorrhage due to ANCA-associated vasculitis and concurrent therapy with continuous venovenous hemodialysis is reported to increase survival. Clinicians should be encouraged to use this life saving mode of treatment more often.