Abstract | BACKGROUND: CASE REPORT: A 31-year-old man presented with right arm weakness, whose symptoms rapidly progressed to hemiplegia and aphasia. The patient was initially managed with glucocorticosteroids. Decompressive craniotomy and brain biopsies were performed when his intracranial pressure increased. Brain biopsy findings were consistent with AHLE. Mycoplasma pneumonia immunoglobulin G and immunoglobulin M serologies revealed recent infection. Despite surgical and medical management, he decompensated on Day 11, and TPE was initiated. The patient received a total of 10 TPE treatments. On the fourth day of TPE treatment, he was extubated. Twenty-one days after TPE began, he was ambulating with near normal muscle strength and was discharged. Four months after initial presentation, the patient has normal strength and is working full-time. CONCLUSIONS: AHLE has a fulminant course requiring accurate and rapid diagnosis. Successful therapy requires aggressive management of intracranial pressure and immunosuppression. Two other reports of AHLE document successful management with TPE. Each of these patients survived with minimal neurologic impairments. Given the likely immune-mediated nature of this disease, combined treatment of steroids, surgery, and TPE may lead to shorter hospital stays and improved neurologic outcomes. Clinical studies are needed to further study the effect of TPE on neurologic outcome in AHLE.
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Authors | Lori J Ryan, Robert Bowman, Nicole Dodge Zantek, Gregory Sherr, Robert Maxwell, H Brent Clark, David C Mair |
Journal | Transfusion
(Transfusion)
Vol. 47
Issue 6
Pg. 981-6
(Jun 2007)
ISSN: 0041-1132 [Print] United States |
PMID | 17524086
(Publication Type: Case Reports, Journal Article, Review)
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Chemical References |
- Antibodies, Bacterial
- Glucocorticoids
- Immunoglobulin G
- Immunoglobulin M
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Topics |
- Adult
- Antibodies, Bacterial
(blood)
- Aphasia
(blood, microbiology, pathology)
- Biopsy
- Brain
(microbiology, pathology)
- Craniotomy
- Glucocorticoids
(therapeutic use)
- Hemiplegia
(blood, microbiology, pathology)
- Humans
- Immunoglobulin G
(blood)
- Immunoglobulin M
(blood)
- Leukoencephalitis, Acute Hemorrhagic
(blood, diagnosis, etiology, microbiology, pathology, therapy)
- Male
- Mycoplasma Infections
(blood, complications, diagnosis, pathology, therapy)
- Mycoplasma pneumoniae
- Plasma Exchange
- Time Factors
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