Rituximab Causing Deep Ulcerative Suppurative Vaginitis/Pyoderma Gangrenosum

Selva-Nayagam, Priya; Fischer, Gayle; Hamann, Ian; Sobel, Jack D.; James, Craig

doi:10.1007/s11908-015-0478-5

Cited by 24 publications

(30 citation statements)

References 30 publications

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“…Our literature search yielded 26 articles, which describe 43 cases of PG treated with IVIG (see Fig. and Table S1; see Supporting Information) . The retrospective review identified six patients with PG treated with IVIG at our institutions.…”

Section: Resultsmentioning

confidence: 99%

Intravenous immunoglobulin as adjunct therapy for refractory pyoderma gangrenosum: systematic review of cases and case series

2018

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Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis. Treatment regimens for refractory cases are nonstandardized. Intravenous immunoglobulin (IVIG) is an emerging treatment with reported success, but the efficacy of IVIG for PG is unknown. In this systematic review of cases and case series, we assessed the efficacy of IVIG for the treatment of PG, as observed at our institution and reported in the literature. A retrospective chart review at two tertiary care hospitals between 2000 and 2015, and literature searches in PubMed/MEDLINE, EMBASE and Web of Science from all years were conducted. In total, there were 49 patients, including 43 patients from 26 articles and six institutional cases. There was complete or partial response in 43 (88%) patients and complete response in 26 (53%) patients. The mean time to initial response to treatment and treatment length were 3·5 (SD 3·3) weeks and 5·9 (SD 7·8) months, respectively. On average, 2·6 treatments had been trialled before IVIG initiation. IVIG was administered with systemic steroids in 43 (88%) cases. Mild adverse events, especially nausea and headache, were reported in 12 (24·5%) patients. Our systematic review suggests a potential role for IVIG as adjuvant therapy for refractory PG. Prospective clinical trials testing the efficacy of IVIG for refractory PG are needed to validate these findings.

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Section: Resultsmentioning

confidence: 99%

Intravenous immunoglobulin as adjunct therapy for refractory pyoderma gangrenosum: systematic review of cases and case series

2018

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“…Its use in idiopathic PG has not been reported and paradoxically, rituximab has been implicated as the cause of vulvovaginal PG. 6 These two cases illustrate previously unreported rare skin conditions predating the diagnosis of B-CLL, in which definitive treatment of the primary hematological condition resulted in resolution of these skin manifestations refractory to multiple immunosuppressive treatments. These improvements are postulated to be probably because of an indirect effect of the rituximab and/or multi-agent chemotherapy on the immune dysregulation arising from the malignant B-cell clones rather than a direct therapeutic effect on the skin lesions since in both of our cases, there was a lack of significant B-cell infiltrates in the skin biopsies prior to commencing B-CLL treatment.…”

mentioning

confidence: 70%

Rare skin manifestations successfully treated with primary B‐cell chronic lymphocytic leukemia treatment

et al. 2016

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“…This includes severe reactions such as toxic epidermal necrolysis. The biologic agent rituximab can cause severe ulceration of the vagina and vestibule . Allergic reactions to topical medications, latex in condoms and semen can also involve the vestibule…”

Section: Dermatological Considerationsmentioning

confidence: 99%

The vaginal vestibule: assessing the case for an anterior and posterior division

Haylen

Fischer

et al. 2016

Neurourology and Urodynamics

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The vaginal vestibule has not been the subject of a dedicated journal article. Recent terminology has suggested its division into anterior and posterior components. The case for this division has not yet been assessed. Both components extend laterally from the hymen to the junction with the labia minora. The posterior vaginal vestibule is proposed to extend from the posterior aspect of the hymen to the anterior edge of the perineum whilst the anterior vestibule extends from the posterior aspect of the hymen to just below the clitoris. Anatomical considerations (differing layers) might firstly support the above division. The posterior vestibule, by necessity, is far more flexible with the superficial aspect (approximately 1.5 cm), anatomically and histologically, comprising skin and subcutaneous tissue, with perineal musculature deep to this. In turn, it is more likely to be subject to obstetric and surgical considerations than the anterior vaginal vestibule. Obstetric trauma, in particular, would tend to create defects, particularly at its posterior margin. Many dermatological and microbiological considerations may be common to both anterior and posterior vestibule. Any dermatological condition of the vestibule can result in sexual dysfunction and can be complicated by secondary muscular spasm. Congenital anomalies will differ anteriorly and posteriorly. Multiple considerations can be identified to support the case for division of the vaginal vestibule into anterior and posterior components. Neurourol. Urodynam. 36:979-983, 2017. © 2016 Wiley Periodicals, Inc.

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Rituximab Causing Deep Ulcerative Suppurative Vaginitis/Pyoderma Gangrenosum

Cited by 24 publications

References 30 publications

Intravenous immunoglobulin as adjunct therapy for refractory pyoderma gangrenosum: systematic review of cases and case series

Intravenous immunoglobulin as adjunct therapy for refractory pyoderma gangrenosum: systematic review of cases and case series

Rare skin manifestations successfully treated with primary B‐cell chronic lymphocytic leukemia treatment

The vaginal vestibule: assessing the case for an anterior and posterior division

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