title: Extracorporeal monocyte granulocytapheresis was effective for a patient of erythema nodosum concomitant with ulcerative colitis.
abstract: We report an erythema nodosum (EN) patient whose condition became apparent during the clinical course of ulcerative colitis (UC). The patient relapsed frequently in spite of taking a high dose adrenocortical steroid during his morbidity period of UC. Monocyte-granulocytapheresis (M-GCAP) was combined with 5-aminosalicylic acid 2250 mg/day peroral and once a day of steroid enema. Monocyte-granulocytapheresis was performed once a week for 5 weeks, and succeeded in inducing clinical remission for both UC and EN. The immunological and clinical connections between UC and EN have never been fully elucidated. In this case, because the symptoms of UC and EN revealed parallel improvement after his inflammatory reaction had been brought under control by combining M-GCAP therapy, we hypothesize that the onset of EN appeared as a result of the patient's long-term, treatment-resistant immuno-disturbance, which first appeared as symptoms of UC. Immunomodulative effects induced by M-GCAP might help to control other chronic non-specific inflammations not concerned with targeted organ(s).
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. kebe@hyo-med.ac.jp
authors.forename: Ken
authors.initials: K
authors.lastname: Fukunaga
authors.forename: Koji
authors.initials: K
authors.lastname: Sawada
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Yoshika
authors.initials: Y
authors.lastname: Matoba
authors.forename: Masaru
authors.initials: M
authors.lastname: Natsuaki
authors.forename: Kunio
authors.initials: K
authors.lastname: Ohnishi
authors.forename: Shin
authors.initials: S
authors.lastname: Fukui
authors.forename: Masamichi
authors.initials: M
authors.lastname: Satomi
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimoyama
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000150:complications* / Q000175:diagnosis; D003113:Colonoscopy; D004893:Erythema Nodosum / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D005500:Follow-Up Studies; D006098:Granulocytes / Q000276:immunology; D006801:Humans; D007937:Leukapheresis / Q000379:methods*; D035002:Lower Extremity; D008297:Male; D009000:Monocytes / Q000276:immunology; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome