Recalcitrant pyoderma gangrenosum treated with parenteral iron sucrose therapy

CASE REPORT A 30-year-old woman with a history of Crohn’s disease presented to the clinic shortly after placement of a diverting ileostomy with peristomal purulence, ulceration, and erythema (Fig 1). Biopsy-proven PG was diagnosed, and she was started on prednisone and intralesional triamcinolone. Over the next 10 years, she was prescribed various combinations of cyclosporine, intralesional triamcinolone, mycophenolate mofetil, dapsone, topical cyclosporine, colchicine, etanercept, and prednisone for repeated peristomal PG flares. These medications prevented severe painful flares but failed to cure the chronic peristomal ulcerations. During this time of multiple medication trials, her Crohn’s disease was in remission, requiring no additional Crohn’s-specific medication. Throughout the course of her treatment, the patient experienced significant fatigue, and her hemoglobin level oscillated between 9.2 and 11.7 g/dL (normal, 12.3-15.7 g/dL) with ferritin levels less than 50 ng/mL (normal, 10-250 ng/mL). Iron studies suggested a combination of anemia of chronic disease and iron deficiency anemia; thus, she received six parenteral iron sucrose infusions over the course of 6 months. After the first 3 infusions, her ferritin level increased from 47 to 198 ng/mL. Her fatigue improved temporarily but shortly returned to baseline, and her PG remained stable. She finished