Vulvovaginal Pyoderma Gangrenosum Secondary to Rituximab Therapy

Abstract

Rituximab is being used increasingly for the treatment of B-cell malignancies and nonmalignant conditions. Pyoderma gangrenosum is a rare neutrophilic dermatosis, which can be either idiopathic or associated with underlying systemic inflammatory conditions. We present a series of 4 patients who presented with ulcerative pyoderma gangrenosum in the vulvovaginal area after treatment with rituximab.

Therapy of pyoderma gangrenosum in Germany: results of a survey among wound experts

“…However, according to the results of our study, these innovative treatment options have only rarely been used in the treatment of PG in Germany. With regard to the chimeric monoclonal anti‐CD20 antibody rituximab, there have only been single case reports on the treatment of patients with PG . This is also reflected in our analysis with the very rare use of this drug class.…”

“…“Modern” immune modulators ▹Tacrolimus ▹TNF‐α inhibitors –Adalimumab –Etanercept –Infliximab –Ustekinumab ▹IL‐1fl receptor antagonists –Anakinra –Canakinumab ▹Rituximab ▹Intravenous immunoglobulins …”

Drug-induced pyoderma gangrenosum: a model to understand the pathogenesis of pyoderma gangrenosum

“…Cases of drug‐induced PG were mainly gathered from PubMed searches using a variety of combined search terms including ‘pyoderma gangrenosum’, ‘drug‐induced pyoderma gangrenosum’, ‘neutrophilic dermatosis’, ‘treatment’ and ‘therapy’. A list of cases of drug‐induced PG is provided in Table and the proposed pathogenic mechanisms for each drug are illustrated in Figure .…”

Therapie des Pyoderma gangraenosum in Deutschland: Resultate einer Befragung von Experten

“…Diese innovativen Therapieoptionen werden allerdings, entsprechend der Resultate unserer Studie, bislang in Deutschland selten für die Behandlung des PG eingesetzt. Für den chimären monoklonalen Anti‐CD20‐Antikörper Rituximab finden sich in der Literatur für die Therapie von Patienten mit PG lediglich Einzelfallberichte , was sich auch in unserer Analyse in einem nur sehr seltenen Einsatz dieser Substanzklasse widerspiegelt. Schließlich ist eine weitere neue Therapiealternative der humane monoklonaler Antikörper Ustekinumab, der gegen die Zytokine IL‐12 und IL‐23 gerichtet ist .…”