Intensive Frequent Granulocyte Adsorptive Apheresis Therapy for Acute Fulminant Ulcerative Colitis: Two Consecutive Case Reports

Abstract

Granulocyte/monocyte adsorptive apheresis (GMA) therapy is a treatment method for ulcerative colitis (UC). Twice-weekly GMA regimens are usually administered to treat severe UC. Although GMA efficacy is considered frequency-dependent, there is no uniformly accepted optimal GMA regimen, and there is insufficient evidence regarding optimal GMA therapy frequency for acute fulminant UC. Case 1 was of a 33-year-old man, and case 2 was of a 20-year-old woman. They were diagnosed with acute fulminant UC and treated with steroid therapy, but exhibited exacerbated UC, and their conditions worsened. We, therefore, initiated intensive frequent GMA therapy (conducted 10-11 times during a 13-day period). In both cases, remission was achieved within two weeks of therapy induction. Herein, we describe two consecutive cases in which rapid remission of acute fulminant UC was achieved without adverse events using intensive frequent GMA therapy. These cases suggest that intensive frequent GMA therapy might induce rapid remission in acute fulminant UC cases and may be more effective than twice-weekly GMA regimens.

Keywords: apheresis; disease severity; granulocyte/monocyte adsorptive apheresis; intensive treatment; rapid remission; ulcerative colitis.

Figure 1. (A) Colonoscopy performed in the previous clinic in Case 1 showing longitudinal ulcers from the ascending to the rectal colon. (B) Case 1 treatment course from day 1 to day 25 following admission. The upper part of the figure displays treatment details. The first GMA session failed because blood access in peripheral blood vessels could not be secured. The middle graphs show diarrhea counts (times/day) and body temperature (℃). The lower graphs show white blood cell count (WBC, counts/µL), platelet count (plate, counts/µL), C-reactive protein level (CRP, mg/dL), and serum albumin level (Alb, g/dL).

CTRX, ceftriaxone; MEPM, meropenem; GMA, granulocyte/monocyte adsorptive apheresis; PSL, prednisolone.

Figure 2. (A) Colonoscopy performed before the treatment course in Case 2 showing continuous rough mucosal lesions and loss of the visible vascular pattern in the sigmoid colon and rectum. (B) Case 2 treatment course from day 1 to day 37 following admission. The upper part of the figure displays treatment details. The first GMA failed because blood access in peripheral blood vessels could not be secured. The middle graphs show diarrhea counts (times/day) and body temperature (℃). The lower graphs show white blood cell count (WBC, counts/µL), platelet count (plate, counts/µL), C-reactive protein level (CRP, mg/dL), and serum albumin level (Alb, g/dL).

GMA, granulocyte/monocyte adsorptive apheresis; PSL, prednisolone.