Wegener's granulomatosis: treatment failure on conventional therapy

We report a patient with Wegener's granulomatosis who was initially stabilized, but later relapsed with multiorgan involvement while taking high oral doses of cyclophosphamide (3.7 mg/kg body weight/day) and prednisolone. Remission was achieved with a combined therapy consisting of intermittent intravenous boluses of cyclophosphamide, oral prednisolone, plasmapheresis and oral trimethoprim-sulfamethoxazole. Discussion includes evaluation of the relative beneficial effect of the four treatment constituents.