Published online Nov 16, 2016. doi: 10.12998/wjcc.v4.i11.369
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
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.