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

Figures

↓  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 1.
↓  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.
Figure 2.

Tables

↓  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 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 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 CR 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.
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