Plasmapheresis and Intravenous Immune Globulin Improve Neurologic Outcome of XXXX Occurring Post Orthotopic Liver Transplant.

@entity1 @entity17 @entity146 @entity16 @entity508 @entity1372 @entity425 @entity2753 @entity6150 @entity912
OBJECTIVE: To report 2 cases of central pontine @entity6150 (CPM) post liver transplantation in which treatment with plasmapheresis and intravenous immune globulin improved expected neurologic outcome. CASE SUMMARY: Two @entity1 who underwent orthotopic liver transplant developed CPM early in their postoperative course. Magnetic resonance imaging of the brain demonstrated severe @entity17 of either the pons or the midbrain, respectively. Both @entity1 developed significant @entity16 , including acute mental status changes, severe @entity425 , @entity508 , and/or prolonged @entity912 . Pretransplant laboratory results indicated serum @entity1372 levels fluctuating between 115 mEq/L and 152 mEq/L. Both @entity1 received 6 days of plasmapheresis (PP) followed by 5 consecutive days of intravenous immune globulin (IVIG). Significant neurologic improvement was experienced at 2 and 4 weeks, respectively, after therapy was initiated. Complete resolution of neurologic symptoms was evident at 1 year follow-up. DISCUSSION: Currently, specific guidelines or recommendations for the treatment of CPM are practically nonexistent. CPM remains a @entity16 that is difficult to treat and may result in permanent significant neurologic sequelae. The etiology and pathogenesis of this disease are unclear, although @entity146 , particularly in the setting of @entity2753 , is the main risk factor. While @entity1 may eventually show some improvement with supportive care, progress is often protracted, and complete resolution of symptoms is exceedingly rare. The severity of the midbrain lesions juxtaposed against the rapidity of symptom resolution in these 2 @entity1 alludes to a potential therapeutic benefit after initiation of therapy with PP and IVIG. CONCLUSIONS: These cases suggest that prompt recognition of CPM and initiation of PP and IVIG may help modulate its progress and improve long-term neurologic outcome.
