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World J Clin Cases. Jun 6, 2020; 8(11): 2092-2101
Published online Jun 6, 2020. doi: 10.12998/wjcc.v8.i11.2092
Cytapheresis for pyoderma gangrenosum associated with inflammatory bowel disease: A review of current status
Kentaro Tominaga, Kenya Kamimura, Hiroki Sato, Masayoshi Ko, Yuzo Kawata, Takeshi Mizusawa, Junji Yokoyama, Shuji Terai
Kentaro Tominaga, Kenya Kamimura, Hiroki Sato, Masayoshi Ko, Yuzo Kawata, Takeshi Mizusawa, Junji Yokoyama, Shuji Terai, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
Author contributions: Tominaga K and Kamimura K wrote the manuscript; Sato H, Ko M, Kawata Y, Mizusawa T, Yokoyama J, and Terai S collected information; all authors read and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no current financial arrangement or affiliation with any organization that may have a direct influence on their work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Kenya Kamimura, MD, PhD, Lecture, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan. kenya-k@med.niigata-u.ac.jp
Received: February 6, 2020
Peer-review started: February 6, 2020
First decision: February 26, 2020
Revised: February 27, 2020
Accepted: May 14, 2020
Article in press: May 14, 2020
Published online: June 6, 2020
Abstract

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis clinically characterized by the presence of painful skin ulcerations with erythematous. As it is frequently associated with inflammatory bowel diseases, including ulcerative colitis, gastroenterologists should be familiar with the disease including therapeutic options. Therefore, we have conducted a review focusing on the cytapheresis for PG in cases of inflammatory bowel diseases. A literature search was conducted to extract studies published in the last 20 years, with information on demographics, clinical symptoms, treatment, and the clinical course from a total of 22 cases reported and our recent case. In most patients, cytapheresis was associated with improvement or resolution of PG after failure of conventional therapeutic options such as corticosteroids, antibiotics, immunosuppressive agents and immunoglobulin. Based on the information summarized, cytapheresis is helpful in the majority of patients with PG refractory to medical treatment associated with inflammatory bowel diseases and could be further studied in a multicenter, randomized trial.

Keywords: Granulocytapheresis, Leucocytapheresis, Cytapheresis, Inflammatory bowel diseases, Pyoderma gangrenosum, Complications

Core tip: Pyoderma gangrenosum is one of the neutrophilic dermatoses often complicated with ulcerative colitis. The corticosteroid and other immune modulator have been used for the treatment, however, as its disease mechanism has not been clarified, there is no additional option for those who showed poor response and refractory to the conventional therapies. Based on the recent reports, we have summarized the clinical course of 23 cases and efficacy of cytapheresis. Although well-designed prospective clinical trials are essential to develop the evidences, however, the information could help physicians in the gastroenterology field to understand the disease and therapeutic options.