Pyoderma Gangrenosum with Ulcerative Colitis Successfully Treated by the Combination of Granulocyte and Monocyte Adsorption Apheresis and Corticosteroids

Abstract

A 36-year-old woman was admitted to our hospital due to swelling and redness of the left lateral malleolus and dorsum of the left foot with severe pain, with a flare-up of ulcerative colitis (UC). A pathologic examination by skin biopsy led to a diagnosis of pyoderma gangrenosum (PG). She was treated with the intravenous administration of prednisolone (60 mg/day), and granulocyte and monocyte adsorption apheresis (GMA) was performed twice-a-week for 5 weeks. This treatment dramatically improved both the skin and colonic mucosal lesions. These results suggest that a combination of GMA and corticosteroids might be recommendable to induce the remission of serious PG complicated with UC.

Pyoderma gangrenosum in an ulcerative colitis patient during treatment with vedolizumab responded favorably to adsorptive granulocyte and monocyte apheresis

“…[18][19][20] Moreover, there have been reports that the combination of cytapheresis and prednisolone improved PG associated with IBD. 21,22 In the present case, though we could not completely deny the possibility of PG as a side effect of VED, we did not strongly suspect it as an adverse event. This patient may have benefited from anti-TNF therapy until she discontinued GLM, and she might have had a relapse of a quiescent EIM because of switching to VED.…”

Successful treatment of pyoderma gangrenosum with granulocyte and monocyte adsorption apheresis

“…The efficacy of GCAP has been reported in some patients with both PG and an inflammatory bowel disease (either UC or CD) , but only seven patients with PG have been successfully treated with this apheretic technique . Case reports on the efficacy of GCAP in PG are limited to Japan, so to the best of our knowledge, this is the first report in Europe.…”

“…Later, it was shown to be effective on various skin conditions, such as generalised pustular psoriasis, psoriatic arthritis, systemic lupus erythematosus skin rash, Behcet's disease and PG (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). The efficacy of GCAP has been reported in some patients with both PG and an inflammatory bowel disease (either UC or CD) (13,18,19), but only seven patients with PG have been successfully treated with this apheretic technique (14)(15)(16)(17). Case reports on the efficacy of GCAP in PG are limited to Japan, so to the best of our knowledge, this is the first report in Europe.…”

Leukocytapheresis in patients with inflammatory bowel diseases

“…Pyoderma gangrenosum is a skin lesion with necrotic areas of irregular ulceration, present in up to 2% of IBD patients, particularly in those with UC [39][40][41]. Until now several cases of pyoderma gangrenosum treated with leukocytapheresis have been reported in IBD patients with good results [42,43]. One of them was a case of 19-year-old male patient with severe CD complicated with pyoderma gangrenosum with extensive refractory skin lesions located on the legs and buttocks.…”

“…Positive clinical response in both bowel symptoms and skin lesions was observed even after the 3 rd GMA session. At the end of 10 sessions of intensive GMA treatment, skin ulcers become dry and crusted and colonic lesions improvements were confirmed by endoscopy [ 43 ].…”