[Pyoderma gangrenosum with lung involvement treated with infliximab]

Ann Dermatol Venereol. 2013 May;140(5):363-6. doi: 10.1016/j.annder.2013.01.428. Epub 2013 Feb 26.
[Article in French]

Abstract

Background: Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis often associated with systemic diseases, particularly chronic inflammatory bowel diseases. Extracutaneous manifestations (articular, ocular, renal, pulmonary, hepatosplenic, muscular) exist, with lung involvement being the most common.

Patient and methods: We report a case of PG with skin and lung involvements in a patient treated with high-dose corticosteroids in a setting of severe ulcerative colitis (UC). Lung involvement was diagnosed during the pretreatment assessment performed prior to initiation of anti-TNFα therapy. Infliximab resulted in rapid improvement of the lung and skin lesions.

Discussion: In the event of simultaneous cutaneous PG lesions and lung lesions suggestive of abscess, visceral involvement should be suspected. First-line treatment consists of oral corticosteroids. In our patient, the occurrence of lesions under corticosteroids in UC militated in favour of anti-TNFα therapy, which proved effective.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / therapeutic use
  • Analgesics / therapeutic use
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / therapeutic use*
  • Colectomy
  • Colitis, Ulcerative / complications*
  • Colitis, Ulcerative / drug therapy
  • Colitis, Ulcerative / surgery
  • Combined Modality Therapy
  • Drug Therapy, Combination
  • Ergocalciferols / therapeutic use
  • Gastrointestinal Hemorrhage / etiology
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / therapeutic use*
  • Infliximab
  • Lung Diseases / diagnostic imaging
  • Lung Diseases / drug therapy*
  • Lung Diseases / etiology
  • Male
  • Omeprazole / therapeutic use
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / drug therapy
  • Postoperative Complications / etiology
  • Proctitis / complications
  • Proctitis / drug therapy
  • Proctitis / surgery
  • Pyoderma Gangrenosum / diagnostic imaging
  • Pyoderma Gangrenosum / drug therapy*
  • Pyoderma Gangrenosum / etiology
  • Tomography, X-Ray Computed

Substances

  • Adrenal Cortex Hormones
  • Analgesics
  • Antibodies, Monoclonal
  • Ergocalciferols
  • Immunosuppressive Agents
  • Infliximab
  • Omeprazole