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E. Cinotti, B. Labeille, J. L. Perrot, B. Pallot‐Prades, F. Cambazard, Certolizumab for the treatment of refractory disseminated pyoderma gangrenosum associated with rheumatoid arthritis, Clinical and Experimental Dermatology, Volume 39, Issue 6, 1 August 2014, Pages 750–751, https://doi.org/10.1111/ced.12393
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Conflict of interest: the authors declare that they have no conflicts of interest.
Pyoderma gangrenosum (PG) is a rare ulcerating skin condition, which can be chronic and may present a therapeutic challenge.1 Despite the scarcity of randomized controlled trials evaluating treatments for PG, the combination of systemic corticosteroids and ciclosporin is usually the first‐line treatment.2 When this combination proves ineffective, less conventional treatments are used. We report a case of severe PG with generalized and multiple lesions associated with rheumatoid arthritis (RA), which was refractory to several treatments but responded successfully to certolizumab.
The patient was a 21‐year‐old woman, who had a 5‐year history of relapsing PG lesions, which were unusually numerous and spread over her entire body surface, but especially on the legs (Fig. 1). Histological examination identified a neutrophilic dermatitis with leucocytoclasia. The patient's personal history included glomerulonephritis associated with perinuclear antineutrophil cytoplasmic antibody‐associated renal vasculitis at the age of 13 years, and severe RA with involvement of the joints of the hands and feet. Many treatments had been tried for the numerous cutaneous lesions and the articular signs and symptoms, but they were either ineffective (prednisone at both low and high doses for 5 years, methotrexate for 4 years, colchicine for 3 years, dapsone for 1 year, thalidomide for 1 year, mycophenolate mofetil for 6 months, high‐dose intravenous immunoglobulin for 6 months, ciclosporin for 5 months and etanercept for 4 months), or were not tolerated by the patient due to severe inflammatory reactions at the injection sites (two injections of adalimumab and 15 days of treatment with anakinra) or were associated with anaphylactoid reactions (two injections of infliximab).
