Plasmapheresis in a patient with angioimmunoblastic lymphadenopathy. Improvement in clinical and immunologic abnormalities
A patient with steroid resistant, allergen related angioimmunoblastic lymphadenopathy underwent a course of six plasmaphereses during a three-week period. A 75% reduction in lymph node size along with the disappearance of her night sweats occurred. Immunologic abnormalities prior to plasmapheresis included the presence of elevated levels of circulating immune complexes, high levels of spontaneous mononuclear cell blastogenesis and abnormal mitogen responses to Conconavalin A and phytohemagglutinin. Following plasmapheresis there was a marked reduction in immune complex levels, and return of spontaneous blastogenesis and mitogen responses to normal levels. Mechanisms for the beneficial effect seen in this patient include removal of: (1) the antigenic stimulus; (2) antigen antibody complexes; and (3) other humoral factors which may modulate lymphocyte or macrophage function. Additional studies of plasmapheresis are warranted in selected patients with allergen related AIL.