Extracorporeal Monocyte Granulocytapheresis was Effective for a Patient of Erythema Nodosum Concomitant withUlcerative Colitis

:  We report an erythema nodosum (EN) patient whose condition becameapparent during the clinical course of ulcerative colitis (UC).The patient relapsed frequently in spite of taking a high dose adrenocorticalsteroid during his morbidity period of UC. Monocyte-granulocytapheresis(M-GCAP) was combined with 5-aminosalicylic acid 2250 mg/dayperoral and once a day of steroid enema. Monocyte-granulocytapheresiswas performed once a week for 5 weeks, and succeeded in inducingclinical remission for both UC and EN. The immunological and clinical connectionsbetween UC and EN have never been fully elucidated. In this case,because the symptoms of UC and EN revealed parallel improvementafter his inflammatory reaction had been brought under control by combining M-GCAP therapy, we hypothesize that theonset of EN appeared as a result of the patient's long-term,treatment-resistant immuno-disturbance, which first appeared as symptomsof UC. Immunomodulative effects induced by M-GCAP might help tocontrol other chronic non-specific inflammations not concerned withtargeted organ(s).