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Case Reports
. 2024 Dec 4;16(6):1674-1690.
doi: 10.3390/neurolint16060122.

Early Therapeutic Plasma Exchange in Pediatric Transverse Myelitis: A Case Report and Scoping Review

Akram Khan  1 , José Peña  1 , Genesis Briceño  1 , Juliann M Gronquist  2 , Khurram Khan  3 , Raju Reddy  1 , Vijayshree Yadav  4 , Asha Singh  4
Affiliations
Case Reports

Early Therapeutic Plasma Exchange in Pediatric Transverse Myelitis: A Case Report and Scoping Review

Akram Khan et al. Neurol Int. .

Abstract

Background/objectives: Transverse myelitis (TM) is a rare, acute inflammatory disorder affecting the spinal cord, with severe potential consequences, particularly in pediatric patients. Therapeutic plasma exchange (TPE) has emerged as a possible intervention for children unresponsive to high-dose corticosteroids. This study explores the efficacy of early TPE in pediatric TM through a case report and scoping review aiming to clarify the therapeutic benefits of TPE when used in conjunction with corticosteroids in children.

Methods: We present a scoping review of existing literature on the early administration of TPE in pediatric patients with TM, supplemented by a case report of a 5-year-old boy with Longitudinally Extensive Transverse Myelitis (LETM), who received early TPE and corticosteroid therapy. Clinical progression, response to TPE, and functional outcomes were documented over a 9-month follow-up period.

Results: Among the reviewed cases, early TPE demonstrated potential to expedite neurological recovery and improve functional outcomes. In our case report, the patient showed rapid recovery, achieving unassisted ambulation by day four of TPE. No adverse effects were observed. MRI findings revealed substantial resolution of spinal cord lesions by three months, with near-complete symptom resolution at nine months.

Conclusions: Early initiation of TPE, in conjunction with corticosteroids, may offer significant therapeutic benefit in pediatric TM, potentially accelerating recovery and improving outcomes. This case highlights the need for further controlled studies to establish evidence-based guidelines for TPE use in pediatric TM.

Keywords: case report; corticosteroids; pediatric neurology; therapeutic plasma exchange; transverse myelitis.

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Conflict of interest statement

A.K. has received research support from 4D Medical, Roche Pharmaceuticals, Dompe Pharmaceuticals, Eli Lily, Direct Biologics and NIH, NHLBI, BARDA. R.R. has received research support from United Therapeutics, Merk. The other authors report no conflicts of interest.

Figures

Figure 1
Figure 1
MRI of the spinal cord showing abnormal T2 hyper-intense signal throughout the spinal cord prior to initiating treatment.
Figure 2
Figure 2
MRI of the spinal cord showing spinal cord lesions improved in appearance after treatment.
See this image and copyright information in PMC

References

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