title: A case report of steroid and immunosuppressant-resistant pyoderma gangrenosum successfully treated by granulocytapheresis.
abstract: Granulocytapheresis (GCAP) therapy is a newly developed therapeutic modality for inflammatory bowel diseases such as ulcerative colitis and Crohn's disease. Pyoderma gangrenosum (PG) is a chronic inflammatory skin disease characterized by the appearance of erythematous macules and plaques with pustules or nodules that rapidly progress to ragged, undermined multiple ulcers. We attempted GCAP therapy in a patient with PG resistant to prednisolone and various other immunosuppressants. GCAP therapy was initiated at three- to four-day intervals and a good response from all skin lesions, with eventual total epithelialization, was observed after 10 sessions of this therapy. Furthermore, circulating levels of inflammatory cytokines such as interleukin-8 (IL-8) and granulocyte colony stimulating factor (G-CSF) also decreased after the GCAP therapy. Our results suggest that GCAP is a safe and useful tool for the treatment of intractable PG, and that IL-8 and G-CSF are likely to be involved in the pathogenesis of PG.
authors.affiliation: Department of Dermatology, Juntendo University School of Medicine, Tokyo, Japan. kuma@med.juntendo.ac.jp
authors.forename: Keiko
authors.initials: K
authors.lastname: Okuma
authors.forename: Kouichi
authors.initials: K
authors.lastname: Mitsuishi
authors.forename: Toshio
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tsuchihashi
authors.forename: Hideoki
authors.initials: H
authors.lastname: Ogawa
authors.forename: Shigaku
authors.initials: S
authors.lastname: Ikeda
mesh_terms: D000328:Adult; D016207:Cytokines / Q000502:physiology; D006098:Granulocytes; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007937:Leukapheresis; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use*; D017511:Pyoderma Gangrenosum / Q000628:therapy*
chemical_list: D016207:Cytokines; D007166:Immunosuppressive Agents; D011239:Prednisolone