Dextran sulfate (Selesorb) plasma apheresis improves vascular changes in systemic lupus erythematosus.
Apheresis has been effective as rescue therapy in patients with severe, therapy-resistant, systemic lupus erythematosus (SLE). Its benefit in patients with less severe but therapy-resistant SLE is not known. Dextran sulfate apheresis was applied as a rescue therapy for therapy-resistant vasculitic skin lesions in a 30 year old female patient with a 9 year history of SLE in combination with antiphospholipid syndrome and Raynaud's phenomenon. Partial remission was achieved after 9 immunoadsorption sessions, as documented by marked improvement of skin lesions and an increase of capillary density in the nailfold area. Further improvement was noted with maintenance therapy using mycophenolate mofetil. Dextran sulfate apheresis can be applied safely in patients with moderate therapy-resistant SLE disease activity when severe immunodeficiency and cytotoxic adverse effects should be avoided.
Braun
Norbert
N
Sektion Nieren- und Hochdruckkrankheiten der Medizinische Klinik und Poliklinik, Tübingen, Germany. nbraun@uni-tuebingen.de
Jünger
Michael
M
Klein
Reinhild
R
Gutenberger
Sylvia
S
Guagnin
Michael
M
Risler
Teut
T
D000327:Adsorption; D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D001781:Blood Component Removal; D003165:Complement System Proteins / Q000032:analysis; D016264:Dextran Sulfate; D005260:Female; D005385:Fingers / Q000098:blood supply; D006801:Humans; D007136:Immunoglobulins / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D020678:Microscopic Angioscopy; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010956:Plasmapheresis; D017445:Skin Diseases, Vascular / Q000150:complications / Q000473:pathology / Q000628:therapy
D000974:Antibodies, Antinuclear; D007136:Immunoglobulins; D007166:Immunosuppressive Agents; D003165:Complement System Proteins; D016264:Dextran Sulfate; D009173:Mycophenolic Acid