Severe alcoholic hepatitis successfully treated by leukocytapheresis: a case report.

Background: The prognosis of severe alcoholic hepatitis is poor, and there is no established method for a cure. Methods: A 34-year-old man was admitted to Kurume University Hospital because of severe liver dysfunction due to excess alcohol intake. He was treated with prednisolone and two sessions of granulocyte and monocyte adsorption apheresis (GCAP) using an Adacolumn, which removes leukocytes-especially granulocytes and monocytes-from the peripheral blood. We evaluated the changes in the serum levels of interleukin-6, interleukin-8, tumor necrosis factor-a, and soluble intercellular adhesion molecule-1, as well as the conventional liver tests and peripheral white blood cell count. Results: Prednisolone was effective in the short term but resulted in an increase in C-reactive protein (CRP), peripheral leukocytes, and serum total bilirubin. GCAP performed on the 34th and 41th hospital days produced decreases in the white blood cell count, total bilirubin, and intercellular adhesion molecule-1. The patient survived, despite the expected poor prognosis on admission. Conclusions: GCAP is recommended as a potential therapeutic option for severe alcoholic hepatitis.