Severe Pyoderma Gangrenosum Research Articles

A feasible clinical pathway of severe pyoderma gangrenosum in burn centers based on three clinical cases

ObjectiveTo establish a standardized clinical pathway for the management of severe pyoderma gangrenosum (PG) in burn centers by analyzing and integrating insights from three detailed case studies. Methods and materialsFirst, we sum up experiences about identification and recovery methods for acute and chronic PG-induced wounds by analyzing the characteristics of emergent cases. Second, we analyzed the similarities and differences in the diagnosis and treatment of the clinical cases. Then, a clinical pathway was established by integrating the diagnosis and treatment characteristics of the three cases. ResultsA clinical pathway for severe PG management was developed for use in burn centers, which comprised: (1) Initial Assessment and Potential PG Identification Criteria, (2) Steps for Confirming a PG Diagnosis, (3) Treatment Protocol, and (4) Follow-up and Monitoring. ConclusionPG, as a rapidly progressing rare inflammatory skin disorder, is often misdiagnosed and treated inappropriately. The unpredictable course and the lack of standardized treatment protocols for PG makes its management challenging. The clinical pathway established in this study comprises a timely diagnostic process and optimizes treatment strategies, ultimately enhancing the quality of care for patients with PG. Future studies are needed to validate this pathway and explore its applicability in different clinical settings.

PA26 Severe pyoderma gangrenosum in a child and the response to adalimumab

PA26 Severe pyoderma gangrenosum in a child and the response to adalimumab

A case of refractory severe pyoderma gangrenosum successfully treated with upadacitinib

A case of refractory severe pyoderma gangrenosum successfully treated with upadacitinib

Bone and Skin/Subcutaneous Tissue Concentrations of Cefiderocol During Treatment of Extensively Drug-Resistant Pseudomonas aeruginosa.

Pyoderma gangrenosum is a rare dermatologic disorder that disrupts the skin barrier, requiring immunosuppressive therapy. We successfully used cefiderocol for the treatment of an extensively drug-resistant Pseudomonas aeruginosa bacteremia, and presumed osteomyelitis in a patient with severe pyoderma gangrenosum and associated immunosuppressive therapy while being medically optimized for skin grafting. We obtained bone and skin/subcutaneous tissue while the patient was on cefiderocol under an institutional review board-approved biologic waste recovery protocol. Cefiderocol concentrations in bone and skin/subcutaneous tissue were 13.9 and 35.9 mcg/g, respectively. The patient recovered from bacteremia and underwent autografting without further complications. Cefiderocol at approved dosing of 2 g IV (3-hour infusion) every 8 hours resulted in bone and skin/subcutaneous tissue concentrations adequate to treat extensively drug-resistant Gram-negative bacteria that remain susceptible to cefiderocol.

11 Spesolimab use in treatment of severe pyoderma Gangrenosum

11 Spesolimab use in treatment of severe pyoderma Gangrenosum

When The Cart Is Before The Horses - Pyoderma Gangrenosum As Preceding Idiopathic Ulcerative Colitis: First Report in Gambia

Chronic inflammatory bowel disease is characterized by a plethora of intestinal and extra-intestinal manifestations, and it is not difficult to establish its diagnosis when all the elements are present; however, when the extra-intestinal manifestations precede and are more severe than the intestinal symptoms themselves, then it becomes a diagnostic challenge, delaying treatment, affecting quality of life, and darkening its prognosis. We report a case with six-months onset of necrotic ulcerative lesions, compatible with severe pyoderma gangrenosum, as the first and only manifestation of the disease during first four months, with only and vague symptoms of intestinal manifestations such as abdominal pain, and diarrhea with phlegm and rarely with blood last two months. Diagnosis of ulcerative colitis was established through colonoscopy, with the biopsy being non-specific in the diagnosis of colitis. The response of the dermatological manifestations was spectacular to conventional therapy with steroids and salicylates.

Giant and severe pyoderma gangrenosum: about a case

Pyoderma gangrenosum is a non infectious neutrophilic dermatosis with unknown origin. In contrast to its name, PG is neither an infectious nor gangrenous condition. Half of the cases have associated systemic diseases.1 Here in, we report a case of a 46-year-old male with no significant history of malignancies, systemic vasculitis, arthritis, inflammatory bowel disease, fungal infection, drugs, or cutaneous injury was referred to our Department for multiple ulcers appears on the trunk and limbs evolving with relapses and remissions. Clinical examination showed diffusely distributed, two, well-defined, deep purulent ulcers on the back and the calf measuring 4 to 40 cm, with severe oozing and erosions. Laboratory tests revealed a white cell count of 10.23×109/l, hemoglobin 120g/l, and C-reactive protein 12 mg/l. All other tests were normal, including hepatic function tests, renal tests, antinuclear antibodies, anti-neutrophil cytoplasmic antibodies, HIV, hepatitis, and Venereal Disease Research Laboratory test for syphilis. A body scan and colonoscopy were performed and was normal. The patient was treated with systemic glucocorticoids (60mg daily) and topical wound care with partial improvement.

Severe pyoderma gangrenosum unresponsive to etanercept and adalimumab

Background: A 74-year-old female with severe and therapy-resistant pyoderma gangrenosum (PG) was treated for more than 40 years with topical antibacterial ointments, topical and systemic corticosteroids, dapsone and azathioprine. Generally, immunosuppression is the mainstay of treatment of PG, but in our patient cyclosporine had to be discontinued because of significant serious side effects. An attempt was made to decrease the amount of steroids, but tapering of the prednisone dose resulted in relapses of PG. Observation: Off-label use of etanercept resulted in a temporary limited clinical improvement. After 6 months, initial clinical improvement reduced and adalimumab was started. Unfortunately, after 6 months of adalimumab no clinical improvement was seen. Therefore, systemic corticosteroids had to be continued with very good clinical results. Conclusion: In concordance with previous results of several other studies, reviews and case reports, we presume that possibly both etanercept and adalimumab could be excellent therapeutic alternatives in the treatment of PG. Unfortunately, the effectiveness of both etanercept and adalimumab were very limited in our case. Literature research revealed no other successful studies on the off-label use of other immunomodulators as an alternative treatment option for PG. However, infliximab or ustekinumab could be alternative treatment options.

Treatment of gangrenous pioderma with rifampicine.

Pyoderma gangrenosum is an entity of unknown etiology, with diverse expressions, mainly on skin. Their differential diagnosis are difficult and broad, and do not have a clear therapy of choice. The response to therapy is variable, with failure in many opportunities. A case of a 40 year old woman with extensive and severe pyoderma gangrenosum having 5 years of evolution is discussed. Her therapy response to multiple medications had been poor but she showed a dramatic answer to rifampicine.

Successful treatment of severe pyoderma gangrenosum with pimecrolimus cream 1%

Successful treatment of severe pyoderma gangrenosum with pimecrolimus cream 1%

Dramatic Improvement of Pyoderma Gangrenosum with Infliximab in a Patient with PAPA Syndrome

Infliximab, a chimeric antitumor necrosis factor alpha monoclonal antibody (anti-TNF alpha), has been recently shown to have a beneficial effect on pyoderma gangrenosum associated with inflammatory bowel disease. Patients with the syndromic triad of pyogenic sterile arthritis, pyoderma gangrenosum, and acne, an autoinflammatory process caused by mutations in the CD2 binding protein-1 (CD2BP1) gene, can have severe pyoderma gangrenosum. We describe a 14-year-old patient with this syndrome who was unresponsive to multiple therapies. A dramatic improvement in his pyoderma gangrenosum was observed after one infusion of infliximab, and a second infusion led to its resolution. Our observation extends the therapeutic use of infliximab to this component of PAPA syndrome.

Infliximab for treatment of pyoderma gangrenosum associated with inflammatory bowel disease

Objectives Pyoderma gangrenosum is an immune-mediated inflammatory condition characterized by ulcerative skin lesions affecting 1–2% of patients with inflammatory bowel disease (IBD). Treatment includes wound care, antibiotics, corticosteroids, and immunomodulators. However, response to therapy varies, and many patients with pyoderma gangrenosum have disease that is refractory to these agents. The aim of this study was to assess the response of medically refractory pyoderma gangrenosum to infliximab. Methods This was a multicenter retrospective study of patients with IBD and medically refractory pyoderma gangrenosum treated with infliximab. Data collected included the following: baseline demographics; duration of IBD; history of bowel resection; duration of skin lesions; number, size, and location of pyoderma gangrenosum lesions; prior medications; dose and number of infliximab infusions; bowel activity before and after infliximab; pyoderma gangrenosum activity before and after infliximab therapy; time to response and time to healing of pyoderma gangrenosum lesions; recurrence of pyoderma gangrenosum after infliximab; corticosteroid taper; and adverse reactions to infliximab. Results There were 13 patients with moderate to severe pyoderma gangrenosum and IBD treated with infliximab. All patients demonstrated complete healing of the skin lesions. Three patients had a complete response to induction infliximab therapy and did not require additional treatment. Ten patients responded to induction infliximab and have maintained pyoderma gangrenosum healing with infusions every 4–12 wk. All patients receiving corticosteroids were able to discontinue them completely after institution of infliximab treatment. Infliximab was well tolerated; the only treatment-related adverse events were sunburn in one patient and an infusion reaction in another. Conclusion Infliximab is a safe and effective treatment for IBD-associated pyoderma gangrenosum.

Infliximab for treatment of pyoderma gangrenosum associated with inflammatory bowel disease.

Pyoderma gangrenosum is an immune-mediated inflammatory condition characterized by ulcerative skin lesions affecting 1-2% of patients with inflammatory bowel disease (IBD). Treatment includes wound care, antibiotics, corticosteroids, and immunomodulators. However, response to therapy varies, and many patients with pyoderma gangrenosum have disease that is refractory to these agents. The aim of this study was to assess the response of medically refractory pyoderma gangrenosum to infliximab. This was a multicenter retrospective study of patients with IBD and medically refractory pyoderma gangrenosum treated with infliximab. Data collected included the following: baseline demographics; duration of IBD; history of bowel resection; duration of skin lesions; number, size, and location of pyoderma gangrenosum lesions; prior medications; dose and number of infliximab infusions; bowel activity before and after infliximab; pyoderma gangrenosum activity before and after infliximab therapy; time to response and time to healing of pyoderma gangrenosum lesions; recurrence of pyoderma gangrenosum after infliximab; corticosteroid taper; and adverse reactions to infliximab. There were 13 patients with moderate to severe pyoderma gangrenosum and IBD treated with infliximab. All patients demonstrated complete healing of the skin lesions. Three patients had a complete response to induction infliximab therapy and did not require additional treatment. Ten patients responded to induction infliximab and have maintained pyoderma gangrenosum healing with infusions every 4-12 wk. All patients receiving corticosteroids were able to discontinue them completely after institution of infliximab treatment. Infliximab was well tolerated; the only treatment-related adverse events were sunburn in one patient and an infusion reaction in another. Infliximab is a safe and effective treatment for IBD-associated pyoderma gangrenosum.

Severe peristomal pyoderma gangrenosum: A case study

Pyoderma gangrenosum is an autoimmune disease that often manifests itself as painful ulcers. When these ulcers occur in the peristomal area, symptom management and wound care must be balanced against the need to pouch the stoma. Although the treatment of pyoderma gangrenosum is not standardized, systemic steroid therapy is frequently used as first-line therapy. The WOC nurse is often asked to manage both the pouching needs and topical therapy of the patient with peristomal pyoderma ulcerations. This article describes the management of severe pyoderma gangrenosum ulcerations in a 59-year-old woman with a long-standing ileostomy.

Aberrant Neutrophil Trafficking and Metabolic Oscillations in Severe Pyoderma Gangrenosum

Having previously associated metabolic oscillations with cell locomotion, we hypothesized that patients with abnormalities in neutrophil trafficking may display aberrant intracellular oscillations. A pyoderma gangrenosum patient exhibiting aberrant leukocyte trafficking in vivo and skin ulceration without infection was identified. This patient's neutrophils constitutively overexpressed and clustered the leukocyte integrins CR3 and CR4 and failed to display appropriate integrin-to-GPI receptor interactions. Increased levels of tyrosine phosphorylation were observed. NAD(P)H oscillations, which are sinusoidal in normals, were chaotic with multiple frequency components in this patient's neutrophils. Normal cell shape and sinusoidal NAD(P)H oscillations were restored by providing a pulsed electric field to drive metabolic oscillations and by temperature reduction. N-acetyl-D-glucosamine disrupted CR3 clusters and sinusoidal NAD(P)H oscillations returned. Anecdotal reports suggest that local hypothermia is clinically useful for this patient. These data define the first metabolic oscillation-associated disease and suggest that pyoderma gangrenosum can be classified as a dynamical disease at the cellular level.

Resolution of severe pyoderma gangrenosum in a patient with streaking leucocyte factor disease after treatment with tacrolimus (FK 506): Abu-Elmagd K, Van Thiel DH, Jegasothy BV, et al. Ann Intern Med 1993;119:596–606

Resolution of severe pyoderma gangrenosum in a patient with streaking leucocyte factor disease after treatment with tacrolimus (FK 506): Abu-Elmagd K, Van Thiel DH, Jegasothy BV, et al. Ann Intern Med 1993;119:596–606

Pyoderma gangrenosum with altered cellular immunity and dermonecrotic factor.

Summary.— A patient with severe pyoderma gangrenosum, without any other associated conditions, is reported. She was found to present 2 major abnormalities of cellular immunity, i.e. lack of lymphocyte cytotoxicity induced by phytohaemagglutinin and failure of dinitrofluorobenzene sensitization. Intra dermal reactions to tuberculin, trichophytin and candidin were negative, while intradermal injections of streptoccal antigen twice provoked large ulcers at the sites of injection. Dermonecrotic factor was present in her serum. High doses of steroids had to be given to heal her ulcers. Copyright © 1972, Wiley Blackwell. All rights reserved