Ustekinumab for Infliximab Resistant Peristomal Pyoderma Gangrenosum: Case Report

Abstract

Peristomal Pyoderma Gangrenosum is a subtype of Pyoderma Gangrenosum, characterized by a sterile inflammatory neutrophilic dermatosis that occurs near abdominal stomas. Most of these lesions are associated with an underlying disease, most commonly IBD. It can also occur in patients who have had an ileostomy or colostomy for other diseases such as malignancy or diverticular disease [1]. Peristomal pyoderma gangrenosum has been reported with an incidence of 0.6% among all patients with abdominal stomas [2]. Treatment of Peristomal PG often requires a combination of local wound care and systemic medications. Long term immunosuppression and TNF inhibitors are the drugs that have shown efficacy in treating PG. In this case report, we present an evidence of a potential additional line of treatment for peristomal pyoderma gangrenosum. Ustekinumab “Stelara”, a recently FDA approved drug for the treatment of IBD, has shown to be effective in treating our 58-year-old female who has been struggling with a refractory infliximab-resistant Peristomal PG for two years. Ustekinumab is a human IgG1k monoclonal antibody that blocks both IL-12 and IL-23 cytokines disrupting the chronic inflammation that is a hallmark of IBD.