Effectively Using Infliximab to Treat Pyoderma Gangrenosum in a Woman With Ulcerative Colitis - Case Report

Abstract

Pyoderma gangrenosum (PG) is a rare non-infectious neutrophilic dermatosis and its diagnosis is often challenging. Its pathogenesis remains unclear but in almost half of the cases, there is an underlying disease. The incidence of PG in patients with inflammatory bowel disease (IBD) in individual studies ranged from 0.4 to 2.6%. Several case reports and studies suggest infliximab's effectiveness in treating PG. This is the first case report from Kosovo of a successful treatment of PG in ulcerative colitis (UC) using infliximab. Infliximab is a chimeric monoclonal antibody to tumour necrosis factor-alpha (TNF-α) used to treat moderate to severe IBD. Our patient, a 28-year-old female diagnosed with UC developed PG one year later. Due to technical obstacles, skin biopsy was not collected at presentation therefore the diagnosis was made based on clinical presentation after six months. The lesions were typical, ulcerative with localization in the lower part of the right leg as well as in the left hand. Due to the failure of other therapies, we transitioned to infliximab and in the second cycle we saw improvements. This case shows that infliximab can be used to manage UC and its complications. PG should always be suspected in patients with UC with skin changes. A delay in diagnosis causes the appearance of scars, which affect the overall quality of life.