Treatment of pyoderma gangrenosum with thalidomide in a myelodysplastic syndrome case

Abstract

Thalidomide may be used as a treatment option for pyoderma gangrenosum (PG) and myelodysplastic syndrome (MDS). Herein, we aimed to report a patient who was treated well with thalidomide and whose diagnosis was PG with MDS. A 61-year-old man with painless ecchymotic lesions in his right upper extremity was admitted to the hospital in Isparta, Turkey, in January 2015. The lesions were diagnosed as PG. In his anamnesis, it was found that he was diagnosed with MDS 6 years ago and had been treated with cyclosporine at 2×100 mg for 5 years, which was stopped in January 2015. Aspiration from liver lesion revealed the presence of Mycobacterium tuberculosis, so antituberculosis treatment was started. Bone marrow investigation revealed MDS-refractory anemia with excess blasts (7%). For lesions in bilateral upper extremities, thalidomide treatment was started at 50 mg/d. After 1 month from the initiation of thalidomide treatment, the lesions in upper extremities had disappeared. In the literature, there are some reports of patients with PG who were successfully treated with thalidomide. Our patient is a complicated case who simultaneously has MDS, PG, and tuberculosis infection. The reason for thalidomide usage in our patient was the need of immune modulation without immune suppression. Our patient has tolerated the drug well, and excellent response was obtained after 1 month of initiation of thalidomide treatment. To conclude, thalidomide is a very effective drug acting as an immune modulator, which is useful in the clinical management of both MDS and PG.

Post-Operative Pyoderma Gangrenosum: A Long Journey for a Patient with Myelodysplastic Syndrome

“…In steroid refractory PG, thalidomide, tacrolimus, and azathioprine and mycophenolate mofetil have been shown to be effective, however some of these were determined to be unsafe, given the patient’s history of MDS [ 15 , 17 ]. Researchers have searched for efficacious regimens for PG in MDS patients.…”

“…Thalidomide decreases levels of TNF and interleukins. It is also an antiangiogenic medication and enhances re-epithelization by promoting migration of keratinocytes [ 17 ]. Decitabine is another medication that has shown benefit in PG patients with MDS.…”

Penile pyoderma gangrenosum: Successful treatment with thalidomide

“…The mechanism of thalidomide is still not fully understood, but it is known that thalidomide can promote proliferation and migration functions of keratinocytes. It is a very useful agent in skin lesions because it enhances reepithelialization (Malkan, Gunes, Eliacik, & Haznedaroglu, ). Our patient was given thalidomide 50 mg per day with minocycline.…”

Comment on ‘Bullous pyoderma gangrenosum secondary to underlying multiple myeloma: treated with ciclosporin’

“…Low-dose thalidomide was found to be better adjuvant than ciclosporin in our case, and the literature supports its effectiveness in both PG and monoclonal gammopathies. 4,5 The knee localization may be a pathergic response to the frequent kneeling by Indian women in the home. Patients with PG with haematological dyscrasias should have an annual bone marrow examination, as there is a 1% annual risk of progression to multiple myeloma.…”