Winning the Battle after Three Years of Suffering: A Case of a Refractory Pyoderma Gangrenosum Treatment Challenge
| Autor: | Hammam Shereef, Ahmed Hashim, Mohamed A. Mohamed, Heba Habbal, Raai Mahmood, Isra Ibrahim |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Erythema Case Report Diseases of the musculoskeletal system Dapsone Serology 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine medicine skin and connective tissue diseases 030203 arthritis & rheumatology medicine.diagnostic_test business.industry General Medicine Skin ulcer medicine.disease Dermatology RC925-935 Rheumatoid arthritis Skin biopsy Methotrexate medicine.symptom business Pyoderma gangrenosum medicine.drug |
| Zdroj: | Case Reports in Rheumatology, Vol 2021 (2021) Case Reports in Rheumatology |
| ISSN: | 2090-6897 2090-6889 |
| Popis: | Pyoderma gangrenosum is an uncommon inflammatory disorder characterized by neutrophilic infiltration of the skin. It can present as skin papules or pustules that progress into painful ulcers. 30–40% of the cases are associated with other systemic diseases such as inflammatory bowel diseases, rheumatoid arthritis, and proliferative hematological disorders. Uniquely, this condition has been associated with systemic lupus erythematosus (SLE). The rarity of this disorder poses a diagnostic and therapeutic challenge. We present a case of a 55-year-old female with a history of SLE and chronic right leg ulcer, presented with increased pain from the ulcer associated with a mild flare of her cutaneous lupus; examination revealed circumferential skin ulcer measuring about 25 cm extending around the right leg above the ankle with prominent fibrinous material and surrounding erythema. Blood work showed elevated WBC with neutrophilic predominance. Serology revealed a positive ANA, elevated RNP, smith, and SSA/Ro antibodies with normal anti-CCP level. Skin biopsy was taken, and it showed a diffuse neutrophilic and lymphocytic infiltrate consistent with the diagnosis of pyoderma gangrenosum. The patient was then treated with topical and systemic steroids and sequentially with dapsone, methotrexate, mycophenolate, and cyclosporine for over a two-year period but failed to show any improvement. Therefore, a trial of intravenous immunoglobulin (IVIG) therapy was attempted and produced a dramatic response after two-month infusions characterized by shrinking in the size of the ulcer and resolving pain. We believe that refractory PG poses a therapeutic challenge, and despite a lack of specific guidelines, IVIG can be attempted if initial suppressive treatment fails to show signs of improvement. |
| Databáze: | OpenAIRE |
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