Activated granulocytes, monocytes, and platelets appear to be closely involved in active
Crohn's disease (CD). Adsorptive granulocyte
apheresis (GCAP) is a new treatment for
inflammatory bowel disease. GCAP was used to treat a 23-year-old female patient with CD resistant to both
infliximab (IFX) and
azathioprine (AZA). At 16 years of age, the patient underwent a partial ileal resection for
peritonitis caused by perforative
ileitis. On pathological examination of the resected specimen, the diagnosis was CD.
Mesalazine was started, but the patient did not comply with
therapy. She was admitted to our hospital again in 2007 due to an acute exacerbation. IFX induction
therapy was started. The combination of both AZA daily and IFX every 8 weeks was continued as maintenance
therapy. However, she developed severe
abdominal pain in September 2009. Computed tomography revealed
ileitis and ascending
colitis, and blood tests showed high inflammatory response marker levels. She was considered to have IFX- and AZA-resistant CD. Initial intravenous
steroid therapy did not result in any improvement. Therefore, weekly GCAP
therapy was given for 5 weeks, which immediately improved the inflammatory response markers. GCAP combined with
prednisolone could be effective for IFX- and AZA-refractory CD.