CASE REPORT article
Front. Med.
Sec. Pulmonary Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1461269
This article is part of the Research TopicCase Reports in Pulmonary Medicine 2024View all 33 articles
Case Report: Rescue "Awake" Extracorporeal Membrane Oxygenation for Acute Respiratory Failure in Severe Granulomatous Polyangiitis with Multisystem Involvement
Provisionally accepted
- Keimyung University Dongsan Hospital, Daegu, Republic of Korea
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We present the case of a 40-year-old man who developed severe acute respiratory failure accompanied by hemoptysis and was subsequently diagnosed with granulomatous polyangiitis (GPA). He was initially managed with high-dose corticosteroids, cyclophosphamide, plasmapheresis, and mechanical ventilation (MV). The patient's condition deteriorated following weaning from MV, prompting transfer to our medical center without reintubation. Upon admission, a high-flow nasal cannula delivering FiO2 of 1.0 was initiated immediately. Despite the severity of hypoxemia, the patient exhibited neither tachypnea nor subjective dyspnea and was subsequently initiated on "awake" Veno venous extracorporeal membrane oxygenation (VV-ECMO) without MV. Anticoagulation therapy was initiated, and continuous renal replacement therapy was commenced to manage anuria associated with acute renal failure. Due to treatment failure following initial immunosuppressive therapy with cyclophosphamide, rituximab was administered as an induction agent. Following 4 cycles of rituximab, the patient's respiratory function showed marked improvement. Subsequently, splenic artery hemorrhage occurred but was effectively managed through prompt embolization, resulting in immediate hemodynamic stabilization.The patient was successfully weaned from VV-ECMO support on the day 22 after starting ECMO. After transfer from the intensive care unit, the patient began active rehabilitation, during which he reported episodes of dizziness. Brain magnetic resonance imaging revealed multiple acute infarctions, presumed secondary to vasculitis, leading to the initiation of adjunctive antiplatelet therapy. This represents the first reported case of refractory severe GPA involving the kidneys, splenic artery, central nervous system, and respiratory failure managed with "awake" VV-ECMO. The patient remains on maintenance hemodialysis and continues treatment with corticosteroids and rituximab. No disease relapse has occurred until now (Jun 2025), and the patient is undergoing rehabilitation for intensive care unit-acquired weakness.
Keywords: Granulomatous polyangiitis, Extracorporeal Membrane Oxygenation, rituximab, Acute Respiratory Distress Syndrome, Splenic artery vasculopathy
Received: 08 Jul 2024; Accepted: 16 Jun 2025.
Copyright: © 2025 Kim, Song and Shin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Tae Hun Kim, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
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