title: The efficacy of intensive granulocyte and monocyte adsorption apheresis in a patient with Crohn's disease complicated by extensive subcutaneous aseptic neutrophilic abscesses.
abstract: OBJECTIVE
  Subcutaneous aseptic abscess is one phenotype of neutrophilic dermatitis. We were interested to see if a case of steroid refractory Crohn's disease (CD) complicated by subcutaneous aseptic neutrophilic abscesses responds to intensive granulocyte/monocyte adsorptive apheresis (GMA).
  
  
  METHODS
  The patient was a 21-year-old male with worsening severe CD while on oral prednisolone (30 mg/day). His symptoms included fever, bloody diarrhoea and multiple painful subcutaneous nodules throughout his body. Skin biopsy showed chronic panniculitis with neutrophilic infiltrates. Further, colonoscopy showed oedematous sigmoid colon, while colonic biopsy showed non-caseous granuloma. Because biologics were feared to increase the risk of bacteraemia as the result of germ culture on his pus was not known at the time, we decided to treat this case with GMA. Five GMA sessions with the Adacolumn over 5 consecutive days (daily GMA) were initiated.
  
  
  RESULTS
  On admission, his CD activity index (CDAI) was 355, C-reactive protein (CRP) 11.2 mg/dL. After 5 GMA sessions, CDAI decreased to 170, and CRP fell to 5.0 mg/dL, with no fever. GMA was restarted at 2 sessions/week (total 10 sessions). The patient's CDAI fell to <150, and the skin lesions re-epithelialized.
  
  
  CONCLUSIONS
  In this CD case complicated by subcutaneous aseptic neutrophilic abscesses, GMA appeared to be effective. Our impression is that when biopsy reveals neutrophil infiltrate is a major feature of the lesions, GMA should be considered. As GMA appears to have no safety concerns, a frequent GMA protocol, like daily followed by 2 to 3 times/week should be preferred over the routine weekly GMA.
authors.affiliation: Department of Gastroenterology and Hepatology, Saitama Medical Centre, Saitama Medical University, Kawagoe City, Saitama, Japan. skato@saitama-med.ac.jp
authors.forename: Shingo
authors.initials: S
authors.lastname: Kato
authors.forename: Eriko
authors.initials: E
authors.lastname: Hosomi
authors.forename: Fumi
authors.initials: F
authors.lastname: Amano
authors.forename: Taisuke
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Kani
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Yamamoto
authors.forename: Tomonari
authors.initials: T
authors.lastname: Ogawa
authors.forename: Akihiko
authors.initials: A
authors.lastname: Matsuda
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sato
authors.forename: Seiichi
authors.initials: S
authors.lastname: Izaki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mitarai
authors.forename: Koji
authors.initials: K
authors.lastname: Yakabi
mesh_terms: D000038:Abscess / Q000209:etiology / Q000628:therapy*; D000328:Adult; D003108:Colonic Diseases / Q000209:etiology; D003424:Crohn Disease / Q000097:blood / Q000150:complications / Q000628:therapy*; D004487:Edema / Q000209:etiology; D006098:Granulocytes; D006801:Humans; D007937:Leukapheresis; D008297:Male; D009000:Monocytes; D012871:Skin Diseases / Q000209:etiology / Q000628:therapy*; D055815:Young Adult