Intest Res.  2022 Jan;20(1):150-155. 10.5217/ir.2020.00148.

Granulocyte and monocyte apheresis therapy for patients with active ulcerative colitis associated with COVID-19: a case report

• Koroku M
• Omori T
• Kambayashi H
• Murasugi S
• Kuriyama T
• Ikarashi Y
• Yonezawa M
• Arimura K
• Karasawa K
• Hanafusa N
• Kawana M
• Tokushige K

• KMID: 2525082
• DOI: http://doi.org/10.5217/ir.2020.00148

Abstract

Coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is now a pandemic. Although several treatment guidelines have been proposed for patients who have both inflammatory bowel disease and COVID-19, immunosuppressive therapy is essentially not recommended, and the treatment options are limited. Even in the COVID-19 pandemic, adjuvant adsorptive granulocyte and monocyte apheresis may safely bring ulcerative colitis (UC) into remission by removing activated myeloid cells without the use of immunosuppressive therapy. Our patient was a 25-year-old Japanese male with UC and COVID-19. This is the first case report of the induction of UC remission with granulocyte and monocyte apheresis treatment for active UC associated with COVID-19.

Keyword

COVID-19; Granulocyte and monocyte adsorptive apheresis; Ulcerative colitis

Figure

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  Fig. 1. Endoscopic images on admission. The Mayo endoscopic subscore was 3, and the ulcerative colitis endoscopic index of severity 5 was a moderate endoscopic finding. Ce, cecum; A/C, ascending colon; T/C, transverse colon; D/C, descending colon; S/C, sigmoid colon; R, rectum.

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  Fig. 2. Contrast-enhanced computed tomography images at the time of admission. Thickening of the intestinal wall was found in continuity from the rectum to the liver curvature. (A) Transverse colon. (B) Liver curvature and ascending colon. (C) Descending colon and sigmoid colon. (D) Sigmoid colon and rectum.

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  Fig. 3. Clinical course. At the time of the first 5 sessions of granulocyte and monocyte apheresis (GMA), the patient’s clinical activity level improved markedly. To bring the patient into further remission, 5 additional GMA sessions were administered, and budesonide foam and eating were resumed. SARS-CoV2, severe acute respiratory syndrome coronavirus 2; PCR, polymerase chain reaction; 5-ASA, 5-aminosalicylic acid.

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