Successful treatment of severe interstitial pneumonia by removal of circulating autoantibodies: a case series.

Abstract

BACKGROUND:

There is only limited clinical data on the benefit of intense immunosuppression in patients with severe interstitial pneumonia associated with autoimmune features or new-onset connective tissue disease.

CASE PRESENTATION:

We here report a series of three consecutive patients suffering from severe interstitial lung disease necessitating endotracheal intubation and mechanical ventilation. The first two patients fulfilled many diagnostic criteria for new-onset antisynthetase syndrome, the third patient for systemic lupus erythematosus. We decided to implement aggressive immunosuppressive strategies in these critically-ill patients including therapeutic plasma exchange, immunoadsorption, cyclophosphamide and rituximab. All three patients improved from respiratory failure, were successfully weaned from the respirator, and eventually dismissed from hospital with ongoing immunosuppressive therapy.

CONCLUSION:

Patients suffering from severe connective tissue disease-associated interstitial lung disease and respiratory failure may benefit from an aggressive immunosuppressive regimen and extracorporeal blood purification with rapid reduction of circulating autoantibodies. The impressive clinical responses in this small case series warrant a controlled clinical trial.

• Authors: Philipp Eller, Holger Flick, Gernot Schilcher, Florentine Moazedi-Fürst, Kathrin Eller, Emina Talakic, Josef Hermann, Yannick Allanore, Horst Olschewski
• Journal: BMC pulmonary medicine (BMC Pulm Med) Vol. 21 Issue 1 Pg. 13 (Jan 06 2021) ISSN: 1471-2466 [Electronic] England
• PMID: 33407317 (Publication Type: Case Reports, Journal Article)

Chemical References

• Autoantibodies
• Immunosuppressive Agents
• Rituximab
• Cyclophosphamide

Topics

• Autoantibodies (blood, drug effects)
• Cyclophosphamide
• Humans
• Immunosuppressive Agents (therapeutic use)
• Lung Diseases, Interstitial (drug therapy, immunology)
• Lupus Erythematosus, Systemic (drug therapy, immunology)
• Male
• Middle Aged
• Myositis (drug therapy, immunology)
• Rituximab
• Treatment Outcome