Rapid Improvement of Pyoderma Gangrenosum Managed with IV Methylprednisolone

Abstract

Here we report a case of pyoderma gangrenosum managed with immunosuppressive therapy. A 55-year-old woman presented with a one week history of several painful nodules on her hands and face that appeared abruptly. She reported similar lesions in the past that resolved without treatment. Her medical history was significant for rheumatoid arthritis for which she was not undergoing treatment due to cost. Physical exam revealed large, ulcerated nodules on the left fifth finger, right fourth finger and left cheek near nostril. Given the negative cultures, and histopathology consistent with the diagnosis of pyoderma gangrenosum, the patient was started on intravenous methylprednisolone. Within five days, the size, depth and associated pain of the ulcers had significantly improved. Therapy was changed to oral prednisone and patient continued to improve after 1 week. Pyoderma gangrenosum is an uncommon cutaneous ulcerative disease that is generally managed with immunosuppressive therapy. Topical corticosteroids may be sufficient to treat mild and local disease while systemic steroids are considered first line therapy for severe and more extensive disease. This case highlights the rapid improvement that can be achieved with systemic immunosuppressive.