Double Filtration Plasmapheresis Treatment of Refractory Multiple Sclerosis Relapsed on Fingolimod: A Case Report
Double filtration plasmapheresis (DFPP) is an emerging semi-selective apheretic method for treating immuno-mediated neurological diseases. Here we report the first case of steroid-refractory relapsed multiple sclerosis (MS) on Fingolimod (FTY), treated effectively by this technique, in a 37-year-old...
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MDPI AG
2020-10-01
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| Series: | Applied Sciences |
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| Online Access: | https://www.mdpi.com/2076-3417/10/21/7404 |
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| author | Roberto De Masi Stefania Orlando Salvatore Accoto |
| author_facet | Roberto De Masi Stefania Orlando Salvatore Accoto |
| author_sort | Roberto De Masi |
| collection | DOAJ |
| description | Double filtration plasmapheresis (DFPP) is an emerging semi-selective apheretic method for treating immuno-mediated neurological diseases. Here we report the first case of steroid-refractory relapsed multiple sclerosis (MS) on Fingolimod (FTY), treated effectively by this technique, in a 37-year-old woman. This condition is thought to be caused by soluble inflammatory species, but its demyelinating pattern is unknown; moreover, despite megadoses of intravenous 6-methyl prednisolone, it induces severe neurological deterioration, but dramatically responded to DFPP in our patient. The clinical improvement was driven by a strong DFPP-induced anti-inflammatory effect, with significant reduction of C3/C4 components, total gamma globulin concentrations (IgG), and gamma-fibrinogen (FGG), resulting in a brain pseudoatrophy phenomenon. Our findings are: first, the steroid-refractory relapsed MS on FTY, however serious, can be treated with DFPP; second, given the good clinical improvement due to the DFPP-induced neuroinflammatory components removal, this clinical condition can be associated with a Lucchinetti pattern II of demyelination. |
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| format | Article |
| id | doaj.art-e99a96d349cb4340a1ff9f5b95e60d4c |
| institution | Directory Open Access Journal |
| issn | 2076-3417 |
| language | English |
| last_indexed | 2024-03-10T15:26:06Z |
| publishDate | 2020-10-01 |
| publisher | MDPI AG |
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| spelling | doaj.art-e99a96d349cb4340a1ff9f5b95e60d4c2023-11-20T18:07:04ZengMDPI AGApplied Sciences2076-34172020-10-011021740410.3390/app10217404Double Filtration Plasmapheresis Treatment of Refractory Multiple Sclerosis Relapsed on Fingolimod: A Case ReportRoberto De Masi0Stefania Orlando1Salvatore Accoto2Multiple Sclerosis Centre, Laboratory of Neuroproteomics, “F. Ferrari” Hospital, 73042 Casarano, Lecce, ItalyMultiple Sclerosis Centre, Laboratory of Neuroproteomics, “F. Ferrari” Hospital, 73042 Casarano, Lecce, ItalyComplex Operative Unit of Nephrology and Dialysis, “F. Ferrari” Hospital, 73042 Casarano, Lecce, ItalyDouble filtration plasmapheresis (DFPP) is an emerging semi-selective apheretic method for treating immuno-mediated neurological diseases. Here we report the first case of steroid-refractory relapsed multiple sclerosis (MS) on Fingolimod (FTY), treated effectively by this technique, in a 37-year-old woman. This condition is thought to be caused by soluble inflammatory species, but its demyelinating pattern is unknown; moreover, despite megadoses of intravenous 6-methyl prednisolone, it induces severe neurological deterioration, but dramatically responded to DFPP in our patient. The clinical improvement was driven by a strong DFPP-induced anti-inflammatory effect, with significant reduction of C3/C4 components, total gamma globulin concentrations (IgG), and gamma-fibrinogen (FGG), resulting in a brain pseudoatrophy phenomenon. Our findings are: first, the steroid-refractory relapsed MS on FTY, however serious, can be treated with DFPP; second, given the good clinical improvement due to the DFPP-induced neuroinflammatory components removal, this clinical condition can be associated with a Lucchinetti pattern II of demyelination.https://www.mdpi.com/2076-3417/10/21/7404multiple sclerosisdouble filtration plasmapheresisfingolimodsteroid-refractory reboundintravenous 6-methyl prednisolone |
| spellingShingle | Roberto De Masi Stefania Orlando Salvatore Accoto Double Filtration Plasmapheresis Treatment of Refractory Multiple Sclerosis Relapsed on Fingolimod: A Case Report Applied Sciences multiple sclerosis double filtration plasmapheresis fingolimod steroid-refractory rebound intravenous 6-methyl prednisolone |
| title | Double Filtration Plasmapheresis Treatment of Refractory Multiple Sclerosis Relapsed on Fingolimod: A Case Report |
| title_full | Double Filtration Plasmapheresis Treatment of Refractory Multiple Sclerosis Relapsed on Fingolimod: A Case Report |
| title_fullStr | Double Filtration Plasmapheresis Treatment of Refractory Multiple Sclerosis Relapsed on Fingolimod: A Case Report |
| title_full_unstemmed | Double Filtration Plasmapheresis Treatment of Refractory Multiple Sclerosis Relapsed on Fingolimod: A Case Report |
| title_short | Double Filtration Plasmapheresis Treatment of Refractory Multiple Sclerosis Relapsed on Fingolimod: A Case Report |
| title_sort | double filtration plasmapheresis treatment of refractory multiple sclerosis relapsed on fingolimod a case report |
| topic | multiple sclerosis double filtration plasmapheresis fingolimod steroid-refractory rebound intravenous 6-methyl prednisolone |
| url | https://www.mdpi.com/2076-3417/10/21/7404 |
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