Efficacy of Granulocyte and Monocyte Adsorption Apheresis for Three Cases of Refractory Pyoderma Gangrenosum

Abstract

Pyoderma gangrenosum presents with chronic skin ulcers and is histologically characterized by neutrophil infiltration throughout the dermis. It is also occasionally associated with ulcerative colitis, a type of inflammatory bowel disease, against which granulocyte and monocyte adsorption apheresis (GCAP) has recently shown remarkable efficacy. We performed GCAP on three refractory cases of pyoderma gangrenosum with painful bilateral leg ulcers and hereby report the results obtained. Patient 1 was a 43-year-old woman with a four-year history of recurrent painful skin ulcers treated with prednisolone and cyclosporine. Patient 2 was a 29-year-old woman who had been suffering from pyoderma gangrenosum with severe pain for two weeks, associated with an 11-year history of ulcerative colitis treated with prednisolone and salazosulfapyridine. Patient 3 was a 63-year-old man with a three-year history of recurrent ulcers with pain, suffering from rheumatoid arthritis treated with prednisolone and cyclophosphamide. The sizes of the lesions were reduced in all three patients following a weekly GCAP treatment for 10 or 11 consecutive weeks, and the re-epithelialization of ulcers were additionally observed in two patients. The pain disappeared dramatically in all three patients following two sessions of GCAP therapy. No adverse effects were observed for up to at least eight months after treatment. We therefore considered GCAP as one effective alternative to currently existing therapies, with regards to refractory cases of pyoderma gangrenosum.

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

“…To date, 15 cases of PG treated with leukocytapheresis (including the present case) have been reported (8,(14)(15)(16)(17)(18)(19)(20) ( Table 2). The efficacy of a twice-weekly regimen has not been confirmed for skin diseases, including PG (17), although the efficacy of the standard GMA regimen has been established in patients with corticosteroidand immunosuppressant-resistant PG (11,18).…”

“…Granulocyte and monocyte adsorption apheresis (GMA) was initially introduced for the treatment of UC (8)(9)(10), and its efficacy has also been confirmed for inflammatory disorders of the skin (11). Here, we report a case of PG associated with UC that showed dramatic response to the combination of GMA and corticosteroids.…”

Management of pyoderma gangrenosum

“…Several cases 23 and leukocyte apheresis has also been used in PG refractory to traditional therapies. 24 Development of antibody technology has been a great advance in the treatment of PG. Infliximab, an anti-TNF chimeric monoclonal antibody used in many conditions including IBD and rheumatoid arthritis, is becoming increasingly popular in the treatment of PG associated with these conditions.…”

Successful treatment of pyoderma gangrenosum with granulocyte and monocyte adsorption apheresis

“…It has been initially approved for the treatment of UC because of activated granulocytes . GCAP has also been reported to be effective for other disorders attributable to activated neutrophils, including PG . Here, we report a case of refractory PG successfully treated by GCAP.…”