DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20201366

An unusual association of pyoderma gangrenosum with ulcerative colitis and thyrotoxicosis successfully treated with infliximab: a case report

Abdullah Abualiat, Hala Edris, Salaheldin Alfadni, Tariq Aziz, Mahmoud Hussein

Abstract


Pyoderma Gangrenosum (PG) is a rare chronic immune-mediated inflammatory dermatosis manifested as painful skin ulceration, commonly affecting the lower limbs. The pathogenesis of the disease is complex. Abnormalities in neutrophil function, dysregulation of the innate immune system, and Tumor Necrosis Factor (TNF) were postulated. An underlying associated systemic disease was reported in more than 50% of PG patients, including inflammatory bowel disease, rheumatoid arthritis, and malignancies, with few cases reported an associated thyroid disease. Authors report a case of extensive PG associated with both ulcerative colitis and thyrotoxicosis co-morbidities not mentioned before in one patient. The patient was successfully treated with the anti-TNF alpha infliximab.


Keywords


Infliximab, Inflammatory bowel disease, Pyoderma gangrenosum, Thyrotoxicosis

Full Text:

PDF

References


Wollina U. Clinical management of pyoderma gangrenosum. Am J Clin Dermatol. 2002 Apr 1;3(3):149-58.

Regueiro M, Valentine J, Plevy S, Fleisher MR, Lichtenstein GR. Infliximab for treatment of pyoderma gangrenosum associated with inflammatory bowel disease. Am J Gastroenterol. 2003 Aug 1;98(8):1821-6.

Langan SM, Groves RW, Card TR, Gulliford MC. Incidence, mortality, and disease associations of pyoderma gangrenosum in the United Kingdom: a retrospective cohort study. J Invest Dermatol. 2012 Sep 1;132(9):2166-70.

Binus AM, Qureshi AA, Li VW, Winterfield LS. Pyoderma gangrenosum: a retrospective review of patient characteristics, comorbidities and therapy in 103 patients. Bri J Dermatol. 2011 Dec;165(6):1244-50.

Schoemann MB, Zenn MR. Pyoderma gangrenosum following free transverse rectus abdominis myocutaneous breast reconstruction: a case report. Annal Plastic Surg. 2010 Feb 1;64(2):151-4.

Ahronowitz I, Harp J, Shinkai K. Etiology and management of pyoderma gangrenosum. Am J Clin Dermatol. 2012 Jun 1;13(3):191-211.

Wollina U, Tchernev G. Pyoderma gangrenosum: pathogenetic oriented treatment approaches. Wiener medizinische Wochenschrift. 2014 Jul 1;164(13-14):263-73.

Gurung P, Kanneganti TD. Autoinflammatory skin disorders: the inflammasome in focus. Trends Mole Med. 2016 Jul 1;22(7):545-64.

Brooklyn TN, Dunnill MG, Shetty A, Bowden JJ, Williams JD, Griffiths CE, et al. Infliximab for the treatment of pyoderma gangrenosum: a randomised, double blind, placebo-controlled trial. Gut. 2006 Apr 1;55(4):505-9.

Peyrin-Biroulet L, Van Assche G, Gómez-Ulloa D, García-Álvarez L, Lara N, Black CM, et al. Systematic review of tumor necrosis factor antagonists in extraintestinal manifestations in inflammatory bowel disease. Clin Gastroenterol Hepatol. 2017 Jan 1;15(1):25-36.

Reichrath J, Bens G, Bonowitz A, Tilgen W. Treatment recommendations for pyoderma gangrenosum: an evidence-based review of the literature based on more than 350 patients. J Am Academy Dermatol. 2005 Aug 1;53(2):273-83.

Kaur N, Mahl TC. Pneumocystis jiroveci (carinii) pneumonia after infliximab therapy: a review of 84 cases. Dige Dis Sci. 2007 Jun 1;52(6):1481-4.