Adalimumab treatment for pyoderma gangrenosum.

نویسندگان

  • Michael P Heffernan
  • Milan J Anadkat
  • David I Smith
چکیده

A 47-year-old woman was referred to Washington University dermatology clinic for a nonhealing ulcer on her right shin of 8 months’ duration. She reported having had a similar ulcer on her left shin 6 years ago. The patient’s medical history was significant for non–insulin-dependent diabetes mellitus, hypertension, and osteoarthritis. On examination, she was found to have a 2 3-cm punched-out ulcer with rolled borders on her right shin. Evaluation of a biopsy specimen taken 6 months prior to presentation showed extensive dermal necrosis with ulceration and abscess formation and microangiopathy manifested by thickening of the capillary walls with fibrinous deposits and microthrombi. The overall histologic findings were thought to be most consistent with atrophie blanche. Furtherevaluationsatpresentation includedacomplete bloodcellcountwithdifferentialandrheumatoidfactor,both of which were within normal limits. She had no reaction to purifiedproteinderivative.Aroutinetissueculturegrewrare Enterococcus species. After 1 month of therapy with minocycline,100mgorally, twicedaily,andUnnawrapswithapplicationofclobetasol0.05%ointment,asecondbiopsyspecimenshowedextensivestasisdermatitis anda full-thickness fibroinflammatory process with no necrobiosis. A diagnosisofpyodermagangrenosum(PG)wasmadebasedon the clinical appearance of the ulcer, absence of a significant infectious pathogen, and histologic findings. The patient was treated with minocycline, 100 mg orally, twice daily, Unna wraps with application of clobetasol 0.05% ointment, and intralesional triamcinolone acetonide injections (Kenalog; Bristol-Myers Squibb, Princeton, NJ). After 3 months of treatment, the patient experienced no improvement. The ulcer was deep, painful, and had increased in size to 3 3.5 cm (Figure 1). A systemic treatment was needed.

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عنوان ژورنال:
  • Archives of dermatology

دوره 143 3  شماره 

صفحات  -

تاریخ انتشار 2007