J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

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Case Report

Volume 17, Number 4, April 2025, pages 240-246

Intensive Granulocyte and Monocyte Adsorptive Apheresis Plus Upadacitinib for Induction Treatment of Refractory Crohn’s Disease

Figure 1. Colonoscopic findings at baseline and 12 weeks in case 1. (a) At baseline, colonoscopy shows marked erythema, edematous mucosa and multiple ulcers fused with the adjacent ulcer in the mucosa of the cecum. (b) At 12 weeks after starting combination therapy, colonoscopy shows decreased vascular patterns with mild erythema in a diffuse (50-75%) area in the cecum.

Figure 2. Colonoscopic findings at baseline and 12 weeks in case 2. (a) At baseline, colonoscopy shows marked erythema and multiple ulcers fused with the adjacent ulcer in the rectal mucosa. (b) At 12 weeks after starting combination therapy, colonoscopy shows a clear vascular pattern with no ulcerated surfaces around a decreased vascular pattern in part of the rectum.

**Table 1.** Baseline Laboratory Findings in Case 1
	Value	Reference range
Alb: albumin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BUN: blood urea nitrogen; Cre: creatinine; CRP: C-reactive protein; Glu: glucose; γ-GTP: gamma-glutamyl transpeptidase; Hb: hemoglobin; Ht: hematocrit; LDH: lactate dehydrogenase; MCH: mean corpuscular hemoglobin; MCV: mean corpuscular volume; PLT: platelet; RBC: red blood cell; TP: total protein; WBC: white blood cell.
Hematology
WBC, /µL	9,100	3,300 - 8,600
Neutrophils, %	71.7	40.4 - 70.0
Lymphocytes, %	9.4	25.0 - 45.0
RBC, × 10⁴/µL	479	386 - 492
Hb, g/dL	14.1	11.6 - 14.8
Ht, %	40.6	35.1 - 44.4
MCV, fL	84.8	83.6 - 98.2
MCH, pg	29.4	27.5 - 33.2
PLT, × 10³/µL	511	158 - 348
Serum biochemistry
TP, g/dL	6.7	6.6 - 8.1
Alb, g/dL	3.2	4.1 - 5.1
AST, U/L	18	13 - 30
ALT, U/L	26	7 - 23
LDH, U/L	170	124 - 222
γ-GTP, U/L	23	9 - 32
BUN, mg/dL	4.1	8 - 20
Cre, mg/dL	0.40	0.46 - 0.79
Glu, mg/dL	118	73 - 109
Na, mmol/L	137	138 - 145
K, mmol/L	3.2	3.6 - 4.8
Cl, mmol/L	97	101 - 108
CRP, mg/dL	10.67	≤ 0.30
Serology
Antigenemia (C-7HRP)	Negative
QuantiFERON	Negative
Stool culture	No pathogenic microbes, Clostridium difficile (-), CD toxin A/B (-)

Table 1. Baseline Laboratory Findings in Case 1

Value

Reference range

Alb: albumin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BUN: blood urea nitrogen; Cre: creatinine; CRP: C-reactive protein; Glu: glucose; γ-GTP: gamma-glutamyl transpeptidase; Hb: hemoglobin; Ht: hematocrit; LDH: lactate dehydrogenase; MCH: mean corpuscular hemoglobin; MCV: mean corpuscular volume; PLT: platelet; RBC: red blood cell; TP: total protein; WBC: white blood cell.

Hematology

WBC, /µL

9,100

3,300 - 8,600

Neutrophils, %

71.7

40.4 - 70.0

Lymphocytes, %

9.4

25.0 - 45.0

RBC, × 10⁴/µL

479

386 - 492

Hb, g/dL

14.1

11.6 - 14.8

Ht, %

40.6

35.1 - 44.4

MCV, fL

84.8

83.6 - 98.2

MCH, pg

29.4

27.5 - 33.2

PLT, × 10³/µL

511

158 - 348

Serum biochemistry

TP, g/dL

6.7

6.6 - 8.1

Alb, g/dL

3.2

4.1 - 5.1

AST, U/L

13 - 30

ALT, U/L

7 - 23

LDH, U/L

170

124 - 222

γ-GTP, U/L

9 - 32

BUN, mg/dL

4.1

8 - 20

Cre, mg/dL

0.40

0.46 - 0.79

Glu, mg/dL

118

73 - 109

Na, mmol/L

137

138 - 145

K, mmol/L

3.2

3.6 - 4.8

Cl, mmol/L

101 - 108

CRP, mg/dL

10.67

≤ 0.30

Serology

Antigenemia (C-7HRP)

Negative

QuantiFERON

Negative

Stool culture

No pathogenic microbes, Clostridium difficile (-), CD toxin A/B (-)

**Table 2.** Baseline Laboratory Findings in Case 2
	Value	Reference range
Alb: albumin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BUN: blood urea nitrogen; Cre: creatinine; CRP: C-reactive protein; Glu: glucose; γ-GTP: gamma-glutamyl transpeptidase; Hb: hemoglobin; Ht: hematocrit; LDH: lactate dehydrogenase; MCH: mean corpuscular hemoglobin; MCV: mean corpuscular volume; PLT: platelet; RBC: red blood cell; TP: total protein; WBC: white blood cell.
Hematology
WBC, /µL	16,900	3,300 - 8,600
Neutrophils, %	85.0	40.4 - 70.0
Lymphocytes, %	7.0	25.0 - 45.0
RBC, × 10⁴/µL	443	386 - 492
Hb, g/dL	13.5	11.6 - 14.8
Ht, %	41.6	35.1 - 44.4
MCV, fL	93.9	83.6 - 98.2
MCH, pg	30.5	27.5 - 33.2
PLT, × 10³/µL	566	158 - 348
Serum biochemistry
TP, g/dL	7.7	6.6 - 8.1
Alb, g/dL	3.8	4.1 - 5.1
AST, U/L	17	13 - 30
ALT, U/L	24	7 - 23
LDH, U/L	154	124 - 222
γ-GTP, U/L	49	9 - 32
BUN, mg/dL	9.7	8 - 20
Cre, mg/dL	0.74	0.46 - 0.79
Glu, mg/dL	92	73 - 109
Na, mmol/L	138	138 - 145
K, mmol/L	4.3	3.6 - 4.8
Cl, mmol/L	100	101 - 108
Fe, µg/dL	34	40 - 188
CRP, mg/dL	1.17	≤ 0.30
Serology
Antigenemia (C-7HRP)	Negative
QuantiFERON	Negative
Stool culture	No pathogenic microbes, Clostridium difficile (-), CD toxin A/B (-)

Table 2. Baseline Laboratory Findings in Case 2

Value

Reference range

Hematology

WBC, /µL

16,900

3,300 - 8,600

Neutrophils, %

85.0

40.4 - 70.0

Lymphocytes, %

7.0

25.0 - 45.0

RBC, × 10⁴/µL

443

386 - 492

Hb, g/dL

13.5

11.6 - 14.8

Ht, %

41.6

35.1 - 44.4

MCV, fL

93.9

83.6 - 98.2

MCH, pg

30.5

27.5 - 33.2

PLT, × 10³/µL

566

158 - 348

Serum biochemistry

TP, g/dL

7.7

6.6 - 8.1

Alb, g/dL

3.8

4.1 - 5.1

AST, U/L

13 - 30

ALT, U/L

7 - 23

LDH, U/L

154

124 - 222

γ-GTP, U/L

9 - 32

BUN, mg/dL

9.7

8 - 20

Cre, mg/dL

0.74

0.46 - 0.79

Glu, mg/dL

73 - 109

Na, mmol/L

138

138 - 145

K, mmol/L

4.3

3.6 - 4.8

Cl, mmol/L

100

101 - 108

Fe, µg/dL

40 - 188

CRP, mg/dL

1.17

≤ 0.30

Serology

Antigenemia (C-7HRP)

Negative

QuantiFERON

Negative

Stool culture

No pathogenic microbes, Clostridium difficile (-), CD toxin A/B (-)

**Table 3.** Clinical Course Through 12 Weeks
No.	Age	Sex	Disease duration (years)	Disease location	Pretreated	Baseline	Treatment	At 12 weeks
CDAI: Crohn’s disease activity index; CR: clinical remission; CRP: C-reactive protein; GMA: granulocyte and monocyte adsorptive apheresis; IFX: infliximab; PSL: prednisolone; SES-CD: Simple Endoscopic Score for Crohn’s disease; UPA: upadacitinib.
1	34	F	4	Colitis-type	-	30	376	29	10.67	+	+	33	6	+	0.01	0
2	26	M	13	Colitis-type	IFX	20	470	23	1.17	+	+	31	1	+	0.01	0

Table 3. Clinical Course Through 12 Weeks

No.

Age

Sex

Disease duration (years)

Disease location

Pretreated

Baseline

Treatment

At 12 weeks

Drugs

PSL (mg)

CDAI

SES-CD

CRP (mg/dL)

UPA

Intensive GMA

CDAI

SES-CD

CRP (mg/dL)

PSL (mg)

CDAI: Crohn’s disease activity index; CR: clinical remission; CRP: C-reactive protein; GMA: granulocyte and monocyte adsorptive apheresis; IFX: infliximab; PSL: prednisolone; SES-CD: Simple Endoscopic Score for Crohn’s disease; UPA: upadacitinib.

Colitis-type

376

10.67

0.01

Colitis-type

IFX

470

1.17

0.01