Journal of Inflammation Research (Feb 2022)
Therapeutic Plasma Exchanges in Combination with High-Dose Steroid-Induced Immunosuppression as an Ultima Ratio Therapy in Severe Coronavirus Disease 2019 (COVID-19): A Case-Series Report
Abstract
Agata Janikowska,1 Jens Soukup,2 Rainer U Pliquett,1 Rabah Abdel-Rahim1 1Department of Nephrology and Diabetology, Carl-Thiem Hospital, Cottbus, Germany; 2Clinic for Anesthesiology, Intensive Therapy and Palliative Medicine, Carl-Thiem Hospital, Cottbus, GermanyCorrespondence: Agata Janikowska, Tel +49 355 46 79592, Fax +49 355 46 2240, Email [email protected]: We present 2 cases of severe Covid-19 with comorbidities (arterial hypertension, obesity, diabetes mellitus) treated with membrane-based therapeutic plasma exchanges in combination with a short-term high-dose immunosuppressive therapy. The therapy has been initiated in an attempt to alleviate the prevalent cytokine storm and to prevent intubation and invasive mechanical ventilation, when a long-term nasal oxygen therapy with a maximum flow rate of 8L/min was insufficient to achieve an adequate oxygenation. Even though patient 2 had to be intubated after the 4th cycle of plasmapheresis due to the exhaustion of the respiratory muscles and the subsequent acquired sepsis with a microbiological evidence of a mixed bacterial-fungal infection, both patients showed a good response to treatment, including improvement of laboratory and radiological findings. To our knowledge, this combination of therapeutic plasma exchange with a high-dose steroid therapy has not been reported previously.Keywords: Covid-19, plasmapheresis, immunosuppression, cytokine storm
