Scientific corner

First Case Report of De Novo Ulcerative Colitis Developing After Orthotopic Liver Transplantation Successfully Treated by Granulocyte and Monocyte Apheresis.

S Ihara 1Y Yamaji 2H Kinoshita 1A Yamada 1Y Hirata 1K Hasegawa 3Y Sugawara 3N Kokudo 3K Koike 1

Transplant Proc 2014 Sep;46(7):2414-7. doi: 10.1016/j.transproceed.2014.02.016.

Background: Immunosuppressants such as tacrolimus and cyclosporine are prescribed long-term after orthotopic liver transplantation (OLT) to prevent allograft rejection. Although these immunosuppressants are known to effectively control ulcerative colitis (UC), some post-OLT patients develop exacerbation of preexisting UC or de novo UC. Although aminosalicylates and corticosteroid courses are usually effective to treat such UC, several patients have developed uncontrollable disease and required colectomies. Case report: We have reported a patient who developed de novo UC after OLT to treat liver cirrhosis and hepatocellular carcinoma associated with hepatitis B virus (HBV) infection. Existence of the HBV infection made us avoid to increase the corticosteroid dose or to use other immunosuppressants such as azathioprine or infliximab. Conclusions: In this patient, granulocyte and monocyte apheresis was highly effective in terms of inducing remission of de novo UC. No adverse event was noted.

Scientific corner

Successful treatment of three cases of generalized pustular psoriasis with granulocyte and monocyte adsorption apheresis.

Akiko Suzuki 1Kunitaka HarunaYuki MizunoYoshiyuki KuwaeYuka OnoKazuko OkumuraOsamu NegiYasuko KonKaori TakeuchiKenji TakamoriShigaku IkedaYasushi Suga,Ther Apher Dial. 2012 Oct;16(5):445-8.

Generalized pustular psoriasis (GPP) is a rare form of psoriasis characterized by the presence of variable numbers of sterile pustules appearing in erythematous and scaly lesions, which are associated with moderate to severe constitutional symptoms. It can be life-threatening especially in the elderly; therefore, medical care must be performed in rapid succession of treatment especially in refractory cases. We have performed granulocyte and monocyte adsorption apheresis (GCAP) on three GPP cases associated with several systemic and laboratory findings. As a result, the edema, erythema and numbers of sterile pustules on the skin lesions were reduced dramatically in all three patients after the first sessions of GCAP therapy. The sizes of the psoriatic lesions were reduced in all three patients following a weekly GCAP treatment for 5 consecutive weeks. Psoriasis area and severity index on discharge had improved in all three patients. No serious adverse effects were observed for up to at least 8 months after treatment. We therefore considered GCAP as one effective alternative to currently existing therapies, especially for recalcitrant cases of GPP.

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