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-alpha, 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 41st 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.
Tsuji
Yoshiyasu
Y
Department of Radiology, Kurume University, School of Medicine, Kurume, Fukuoka, Japan.
Kumashiro
Ryukichi
R
Ishii
Kunihide
K
Arinaga
Teruko
T
Sakamoto
Yoshihiro
Y
Tanabe
Ryo
R
Ogata
Kei
K
Koga
Yuriko
Y
Ide
Tatsuya
T
Ono
Naofumi
N
Tanaka
Eisuke
E
Abe
Hirohiko
H
Sata
Michio
M
D000206:Actuarial Analysis; D000328:Adult; D001706:Biopsy; D002097:C-Reactive Protein / Q000378:metabolism; D003131:Combined Modality Therapy; D006098:Granulocytes / Q000276:immunology; D006519:Hepatitis, Alcoholic / Q000175:diagnosis / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007937:Leukapheresis / Q000379:methods*; D007958:Leukocyte Count; D008099:Liver / Q000276:immunology / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D009000:Monocytes / Q000276:immunology; D011239:Prednisolone / Q000008:administration & dosage; D018570:Risk Assessment; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D007166:Immunosuppressive Agents; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D018799:Intercellular Adhesion Molecule-1; D002097:C-Reactive Protein; D011239:Prednisolone