Watanabe Y, Kamimura K, Iwasaki T, Abe H, Takahashi S, Mizuno KI, Takeuchi M, Eino A, Narita I, Terai S. Case of severe alcoholic hepatitis treated with granulocytapheresis. World J Clin Cases 2016; 4(11): 369-374 [PMID: 27900326 DOI: 10.12998/wjcc.v4.i11.369]
Corresponding Author of This Article
Kenya Kamimura, MD, PhD, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachido-ri, Chuo-ku, Niigata 951-8510, Japan. kenya-k@med.niigata-u.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yukari Watanabe, Kenya Kamimura, Hiroyuki Abe, Shunsaku Takahashi, Ken-ichi Mizuno, Manabu Takeuchi, Shuji Terai, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
Tomohiro Iwasaki, Japan Labor Health and Welfare Organization Tsubame Rosai Hospital, Tsubame, Niigata 959-1228, Japan
Atsushi Eino, Ichiei Narita, Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
Author contributions: Watanabe Y, Kamimura K, Iwasaki T, Abe H, Takahashi S, Mizuno K, Takeuchi M, Eino A, Narita I and Terai S solely contributed to this paper.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Niigata University.
Informed consent statement: Written informed consents were obtained from the patients to present their information.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kenya Kamimura, MD, PhD, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachido-ri, Chuo-ku, Niigata 951-8510, Japan. kenya-k@med.niigata-u.ac.jp
Telephone: +81-25-2272207 Fax: +81-25-2270776
Received: June 27, 2016 Peer-review started: June 29, 2016 First decision: August 5, 2016 Revised: August 6, 2016 Accepted: August 27, 2016 Article in press: August 29, 2016 Published online: November 16, 2016 Processing time: 139 Days and 5.4 Hours
Abstract
Severe alcoholic hepatitis (AH) has a high mortality, and it is associated with encephalopathy, acute renal failure, sepsis, gastrointestinal bleeding, and endotoxemia. The 28-d mortality remains poor (34%-40%), because no effective treatment has been established. Recently, corticosteroids (CS) have been considered effective for significantly improving the prognosis of those with AH, as it prevents the production of pro-inflammatory cytokines. However, CS are not always appropriate as an initial therapeutic option, such as in cases with an infection or resistance to CS. We describe a patient with severe AH complicated by a severe infection caused by the multidrug resistance bacteria (Pseudomonas aeruginosa), and was successfully treated with granulocytapheresis monotherapy without using CS. The experience of this case will provide understanding of the disease and information treating cases without using CS.
Core tip: Severe alcoholic hepatitis (AH) has a high mortality, and it is associated with encephalopathy, acute renal failure, sepsis, gastrointestinal bleeding, and endotoxemia. Corticosteroids (CS) have shown efficacy in patients with AH by inhibiting the production of cytokines. On the other hand, the use of a CS is not always appropriate during the initial stage when the patient is complicated with the infection, gastrointestinal bleeding, etc. which can be progressed by CS. For these cases, granulocytapheresis (GCAP) is expected to significantly improve the prognosis of those with severe AH, as the granulocyte and monocyte apheresis device inhibits liver injury caused by activated neutrophils. We presented here the case successfully treated with GCAP without using CS because of severe infectious status.
