Abstract
We report a case of pyoderma gangrenosum (PG), which was refractory to steroid therapy but successfully treated with combination of predonisolone (PSL) and cyclosporine (CyA). A 33-year-old man with inactive Crohnʼs disease was referred to our department with 5-month history of painful ulcer on the leg. Oral PSL (30 mg/day) was already given under the suspicion of PG in other clinic. Because of poor response to the therapy, treatment with steroid pulse therapy (methyl-PSL at 1g/day for 3 days) was additionally started and followed by oral PSL (60 mg/day), but without obvious effects. On the first visit, physical examination revealed a localized, granulomatously elevated ulcer covered with white-yellowish necrosis on the lateral region of right lower leg. A lesional biopsy showed a diffuse neutrophic infiltrate from the entire dermis to the muscle. In addition, computed tomography revealed deep venous thrombosis (DVT) in veins of the right leg .A diagnosis of PG complicated by DVT in the affected limb was made. Anticoagulant therapy and CyA (3 mg/kg/day) were introduced, resulting in a rapid stabilization of disease activity. After tapering of PSL to 10 mg/day, the remaining ulcer was treated with skin grafting, without relapse of the skin lesions. Although PG is often challenging to manage and requires aggressive local and systemic treatments, no guidelines for treatment have been established. We also survey 10 cases of PG experienced in our clinic over the last 5 years and discuss their treatment.
