Successful Treatment of Plasma Cell-Rich Acute Rejection Using Pulse Steroid Therapy Alone: A Case Report
Despite the recent development of immunosuppressive agents, plasma cell-rich acute rejection (PCAR) has remained refractory to treatment. Herein, we report an unusual case of PCAR that responded well to pulse steroid therapy alone. A 47-year-old man was admitted for a protocol biopsy three months af...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2017-01-01
|
| Series: | Case Reports in Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2017/1347052 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832563853309771776 |
|---|---|
| author | Yo Komatsuzaki Yasuyuki Nakada Izumi Yamamoto Mayuko Kawabe Takafumi Yamakawa Ai Katsuma Haruki Katsumata Aki Mafune Akimitsu Kobayashi Yusuke Koike Hiroki Yamada Jun Miki Yudo Tanno Ichiro Ohkido Nobuo Tsuboi Keitaro Yokoyama Hiroyasu Yamamoto Takashi Yokoo |
| author_facet | Yo Komatsuzaki Yasuyuki Nakada Izumi Yamamoto Mayuko Kawabe Takafumi Yamakawa Ai Katsuma Haruki Katsumata Aki Mafune Akimitsu Kobayashi Yusuke Koike Hiroki Yamada Jun Miki Yudo Tanno Ichiro Ohkido Nobuo Tsuboi Keitaro Yokoyama Hiroyasu Yamamoto Takashi Yokoo |
| author_sort | Yo Komatsuzaki |
| collection | DOAJ |
| description | Despite the recent development of immunosuppressive agents, plasma cell-rich acute rejection (PCAR) has remained refractory to treatment. Herein, we report an unusual case of PCAR that responded well to pulse steroid therapy alone. A 47-year-old man was admitted for a protocol biopsy three months after kidney transplantation, with a stable serum creatinine level of 1.6 mg/dL. Histological examination showed focal aggressive tubulointerstitial inflammatory cell infiltration of predominantly polyclonal mature plasma cells, leading to our diagnosis of PCAR. Three months following three consecutive days of high-dose methylprednisolone (mPSL) therapy, an allograft biopsy performed for therapy evaluation showed persistent PCAR. We readministered mPSL therapy and successfully resolved the PCAR. Although PCAR generally develops more than six months after transplantation, we diagnosed this case early, at three months after transplantation, with focally infiltrated PCAR. This case demonstrates the importance of early diagnosis and prompt treatment of PCAR to manage the development and severity of allograft rejection. |
| format | Article |
| id | doaj-art-83d0a41c43044f42b1793e68252a601b |
| institution | Kabale University |
| issn | 2090-6943 2090-6951 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Transplantation |
| spelling | doaj-art-83d0a41c43044f42b1793e68252a601b2025-02-03T01:12:26ZengWileyCase Reports in Transplantation2090-69432090-69512017-01-01201710.1155/2017/13470521347052Successful Treatment of Plasma Cell-Rich Acute Rejection Using Pulse Steroid Therapy Alone: A Case ReportYo Komatsuzaki0Yasuyuki Nakada1Izumi Yamamoto2Mayuko Kawabe3Takafumi Yamakawa4Ai Katsuma5Haruki Katsumata6Aki Mafune7Akimitsu Kobayashi8Yusuke Koike9Hiroki Yamada10Jun Miki11Yudo Tanno12Ichiro Ohkido13Nobuo Tsuboi14Keitaro Yokoyama15Hiroyasu Yamamoto16Takashi Yokoo17Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JapanDivision of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JapanDivision of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JapanDivision of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JapanDivision of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JapanDivision of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JapanDivision of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JapanDivision of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JapanDivision of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JapanDivision of Urology, The Jikei University School of Medicine, Tokyo, JapanDivision of Urology, The Jikei University School of Medicine, Tokyo, JapanDivision of Urology, The Jikei University School of Medicine, Tokyo, JapanDivision of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JapanDivision of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JapanDivision of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JapanDivision of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JapanDepartment of Internal Medicine, Atsugi City Hospital, Kanagawa, JapanDivision of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JapanDespite the recent development of immunosuppressive agents, plasma cell-rich acute rejection (PCAR) has remained refractory to treatment. Herein, we report an unusual case of PCAR that responded well to pulse steroid therapy alone. A 47-year-old man was admitted for a protocol biopsy three months after kidney transplantation, with a stable serum creatinine level of 1.6 mg/dL. Histological examination showed focal aggressive tubulointerstitial inflammatory cell infiltration of predominantly polyclonal mature plasma cells, leading to our diagnosis of PCAR. Three months following three consecutive days of high-dose methylprednisolone (mPSL) therapy, an allograft biopsy performed for therapy evaluation showed persistent PCAR. We readministered mPSL therapy and successfully resolved the PCAR. Although PCAR generally develops more than six months after transplantation, we diagnosed this case early, at three months after transplantation, with focally infiltrated PCAR. This case demonstrates the importance of early diagnosis and prompt treatment of PCAR to manage the development and severity of allograft rejection.http://dx.doi.org/10.1155/2017/1347052 |
| spellingShingle | Yo Komatsuzaki Yasuyuki Nakada Izumi Yamamoto Mayuko Kawabe Takafumi Yamakawa Ai Katsuma Haruki Katsumata Aki Mafune Akimitsu Kobayashi Yusuke Koike Hiroki Yamada Jun Miki Yudo Tanno Ichiro Ohkido Nobuo Tsuboi Keitaro Yokoyama Hiroyasu Yamamoto Takashi Yokoo Successful Treatment of Plasma Cell-Rich Acute Rejection Using Pulse Steroid Therapy Alone: A Case Report Case Reports in Transplantation |
| title | Successful Treatment of Plasma Cell-Rich Acute Rejection Using Pulse Steroid Therapy Alone: A Case Report |
| title_full | Successful Treatment of Plasma Cell-Rich Acute Rejection Using Pulse Steroid Therapy Alone: A Case Report |
| title_fullStr | Successful Treatment of Plasma Cell-Rich Acute Rejection Using Pulse Steroid Therapy Alone: A Case Report |
| title_full_unstemmed | Successful Treatment of Plasma Cell-Rich Acute Rejection Using Pulse Steroid Therapy Alone: A Case Report |
| title_short | Successful Treatment of Plasma Cell-Rich Acute Rejection Using Pulse Steroid Therapy Alone: A Case Report |
| title_sort | successful treatment of plasma cell rich acute rejection using pulse steroid therapy alone a case report |
| url | http://dx.doi.org/10.1155/2017/1347052 |
| work_keys_str_mv | AT yokomatsuzaki successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT yasuyukinakada successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT izumiyamamoto successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT mayukokawabe successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT takafumiyamakawa successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT aikatsuma successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT harukikatsumata successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT akimafune successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT akimitsukobayashi successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT yusukekoike successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT hirokiyamada successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT junmiki successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT yudotanno successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT ichiroohkido successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT nobuotsuboi successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT keitaroyokoyama successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT hiroyasuyamamoto successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport AT takashiyokoo successfultreatmentofplasmacellrichacuterejectionusingpulsesteroidtherapyaloneacasereport |