Double Filtration Plasmapheresis for Refractory Hypercholesterolemia in Drug-Induced Cholestasis: A Case Report

While lipoprotein apheresis (LA) is established for lipid management in primary biliary cholangitis, the role of apheresis techniques in drug-induced cholestatic liver disease remains unexplored. We report the novel application of double filtration plasmapheresis (DFPP) for rapid reversal of severe hypercholesterolemia in iatrogenic cholestasis, where conventional therapies failed or were contraindicated. A 56-year-old male developed severe cholestatic hepatitis following the use of herbal agents. Laboratory investigation revealed extreme hypercholesterolemia, with a total cholesterol (TC) of 41.39 mmol/L and a low-density lipoprotein cholesterol (LDL-c) of 38 mmol/L. Standard medical therapy proved ineffective. Two sessions of DFPP resulted in > 90% reduction in cholesterol levels and simultaneous improvement in bilirubin and liver enzymes, with sustained normal levels at 1-year follow-up. DFPP may serve as a novel rescue therapy for drug-induced cholestatic hypercholesterolemia, providing simultaneous removal of cholesterol and bilirubin where other treatments are ineffective or at high risk.