A Case of Pyoderma Gangrenosum Complicated with Ulcerative Colitis Successfully Treated by Granulocyte and Monocyte Adsorption Apheresis
0
Citation
17
Reference
10
Related Paper
Abstract:
78 歳，女性。当科初診 21 年前に潰瘍性大腸炎を発症した。当科初診 13 年前より右足に潰瘍が出現し，プレドニゾロン 5～10 mg/day を処方されたが完治しなかった。今回，腹部症状，皮膚潰瘍ともに悪化したため当科を紹介され受診した。皮膚生検にて真皮全層の血管周囲に好中球とリンパ球を主体とした炎症細胞浸潤を認め，各種検査で感染症，血管炎，膠原病は否定的であったため壊疽性膿皮症と診断した。プレドニゾロン 30 mg/day の内服で腹部症状は軽快したが皮膚潰瘍は改善しなかった。糖尿病など複数の基礎疾患を有しており，抗 TNF-α 抗体製剤など免疫抑制に関連する薬剤の追加投与は感染症の危険性が懸念された。追加治療として，抗 α4β7 インテグリンモノクローナル抗体であるベドリズマブが投与されたが皮膚所見に効果を認めず，次に，顆粒球除去療法を計 9 回施行したところ潰瘍の著明な改善を認めた。壊疽性膿皮症は潰瘍性大腸炎など他疾患に併存することが多く，合併する疾患によって保険収載され使用できる治療薬が異なることもあり，皮膚所見以外の疾病治療も併せて他科専門医との緊密な連携が求められることも少なくない。また，近年壊疽性膿皮症に対してプレドニゾロンやシクロスポリンに加えて抗 TNF-α 抗体製剤，顆粒球除去療法，ミコフェノール酸モフェチルなど様々な治療薬が提示されているが，免疫抑制作用を有する薬剤を複数使用することで感染症の危険性が増大することも念頭に診療に臨む必要がある。顆粒球除去療法は潰瘍性大腸炎を含めた特定の疾患を併存した症例のみ保険適用が認められているが，感染症の増悪の危険性がないため，患者背景によっては特に有効な治療として期待される。Keywords:
Monocyte
78 歳，女性。当科初診 21 年前に潰瘍性大腸炎を発症した。当科初診 13 年前より右足に潰瘍が出現し，プレドニゾロン 5～10 mg/day を処方されたが完治しなかった。今回，腹部症状，皮膚潰瘍ともに悪化したため当科を紹介され受診した。皮膚生検にて真皮全層の血管周囲に好中球とリンパ球を主体とした炎症細胞浸潤を認め，各種検査で感染症，血管炎，膠原病は否定的であったため壊疽性膿皮症と診断した。プレドニゾロン 30 mg/day の内服で腹部症状は軽快したが皮膚潰瘍は改善しなかった。糖尿病など複数の基礎疾患を有しており，抗 TNF-α 抗体製剤など免疫抑制に関連する薬剤の追加投与は感染症の危険性が懸念された。追加治療として，抗 α4β7 インテグリンモノクローナル抗体であるベドリズマブが投与されたが皮膚所見に効果を認めず，次に，顆粒球除去療法を計 9 回施行したところ潰瘍の著明な改善を認めた。壊疽性膿皮症は潰瘍性大腸炎など他疾患に併存することが多く，合併する疾患によって保険収載され使用できる治療薬が異なることもあり，皮膚所見以外の疾病治療も併せて他科専門医との緊密な連携が求められることも少なくない。また，近年壊疽性膿皮症に対してプレドニゾロンやシクロスポリンに加えて抗 TNF-α 抗体製剤，顆粒球除去療法，ミコフェノール酸モフェチルなど様々な治療薬が提示されているが，免疫抑制作用を有する薬剤を複数使用することで感染症の危険性が増大することも念頭に診療に臨む必要がある。顆粒球除去療法は潰瘍性大腸炎を含めた特定の疾患を併存した症例のみ保険適用が認められているが，感染症の増悪の危険性がないため，患者背景によっては特に有効な治療として期待される。
Monocyte
Cite
Citations (0)
ABSTRACT Pyoderma gangrenosum is a neutrophilic dermatosis clinically characterised by the presence of painful skin ulcerations with erythematous and undetermined borders and histologically by the presence of neutrophilic infiltrates in the dermis. Granulocyte and monocyte adsorption apheresis, also called granulocytapheresis, is a therapeutic strategy for extracorporeal immunomodulation that selectively removes activated granulocytes and monocytes/macrophages from the peripheral blood. Here, we report a case of a 73‐year‐old patient affected by a severe form of pyoderma gangrenosum presenting with multiple painful ulcers and pustules on his trunk and extremities. The disease was resistant to high doses of methylprednisolone and methotrexate and successfully treated by granulocyte and monocyte adsorption apheresis. To the best of our knowledge, this is the first report on the efficacy of granulocyte and monocyte adsorption apheresis in pyoderma gangrenosum in Europe.
Monocyte
Leukapheresis
Cite
Citations (8)
Monocyte
Cite
Citations (0)
Corticosteroids are effective in bringing about clinical remission for ulcerative colitis. However, relapsed cases are frequently refractory to corticosteroids. In addition, the long-term use of corticosteroids often causes serious side effects. We have already reported that leukocyte apheresis using a centrifugal procedure was effective for patients with corticosteroid-resistant ulcerative colitis after conducting a pilot study in 14 patients. In the present paper, the clinical efficacy of leukocyte apheresis using a centrifugal procedure was evaluated again for corticosteroid-resistant ulcerative colitis. Twenty-three patients with corticosteroid-resistant severely active ulcerative colitis were treated by centrifugal leukocyte apheresis. Eighteen patients (78.3%) achieved clinical remission which was evaluated by the clinical activity index within 4 weeks after apheresis. Both colonoscopic and histological examinations confirmed the beneficial effect of this procedure. No significant side effects were noticed throughout the therapy.
Refractory (planetary science)
Cite
Citations (17)
Abstract: We have studied the effects of granulocyte apheresis in 18 patients with ulcerative colitis and 6 with Crohn's disease who had failed to respond to conventional therapy. Patients were treated with weekly apheresis using a granulocyte removal column (GI, Otsuka Pharmaceutical Co., Ltd., London, U.K.). We found a mean reduction in circulating granulocytes of 1.29 × 10 9 cells/L with no significant alterations in red blood cell monocyte, total lymphocyte, absolute T‐helper, or T‐cytotoxic lymphocyte counts. There were no significant changes in complement levels or immunoglobulin subclasses. There was a signifycant increase in granulocyte adhesion and a reduction in L‐selectin expression. The removal of granulocytes is unlikely to explain the effect of granulocytapheresis. The markedly increased expression of α m integrin/Mac‐1 and low L‐selectin expression alter the capability of granulocytes to migrate to sites of inflammation and may be responsible for the improvement observed in patients treated with granulocyte apheresis.
Monocyte
Leukapheresis
Cite
Citations (54)
Monocyte
Leukapheresis
Cite
Citations (0)
Monocyte
Generalized pustular psoriasis
Cite
Citations (43)
Although histologically relapses in ulcerative colitis are characterized by an intense granulocyte infiltrate, there is evidence both from in vitro function tests and skin window migration studies in vivo that there is defective granulocyte function in ulcerative colitis. We have recently developed a method for non invasively monitoring granulocyte migration to sites of inflammation using indium-111-labelled granulocytes, and have used this technique in fifteen patients with ulcerative colitis. In all fifteen cases there was rapid migration of indium-111-labelled granulocytes to inflamed bowel within 10 min of return of the labelled cells. This study provides no support for a significant granulocyte migration defect in ulcerative colitis.
Cite
Citations (32)
Monocyte
Plateletpheresis
Cite
Citations (0)
Neutrophilic dermatoses are a group of skin disorders characterized by intense epidermal and/or dermal inflammatory infiltrates composed of neutrophils with no evidence of infection [1]. They are often associated with ulcerative colitis and Crohn's disease [2, 3].Granulocyte and monocyte adsorptive apheresis (GMA) is an extracorporeal circulation therapy that effectively removes activated granulocytes and monocytes from peripheral blood to correct imbalances in immunological regulatory mechanisms. [...]
Monocyte
Leukapheresis
Cite
Citations (1)