Abstract
A remarkable therapeutic effect of repeated plasma exchange was observed in one patient with steroid resistant systemic lupus erythematosus who had postpartum exacerbation of disease activity and major side effects of corticosteroid.
The patient was a 31-year-old house wife in puerperium, who was diagnosed as a systemic lupus erythematosus on the basis of butterfly rash, photosensitivity, arthritis, oral ulcers, leukocytopenia, lymphocytopenia, LE cells phenomenon, positive fluorescent anti-nuclear antibody and anti-DNA antibody. At the seventh week after delivery, the disease activity was acutely exacerbated. Although she was treated with increasing dosis, up to 90mg per day, of corticosteroid, the severity of the activity remained unchanged and in addition, the major side effects of the steroid developed. A total of four plasma exchanges of 2.0 litters each was done and resulted in disappearance of high fever, improved lupus symptoms, reduction of circulating immune complexes measured by both polyethylen glycol precipitation method and 125I-Protein A binding method, and improvement of T cell function assessed by lymphocyte blastogenesis induced by PHA and Con A.
It was suggested that plasma exchange may be useful not only in the patient who showed exacerbation of SLE activity following delivery, but also in the patients who have undesired highlevels of circulating immune complexes and impaired T cell function and who are not responsive to even high doses of corticosteroid or have major side effects of corticosteroid.
