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Schroeder C, Verma R, Liu L, Sakhthivel H, Min Tun K, Ramphul K, Singh Dhindsa B. From guts to skin; unmasking risk factors of pyoderma gangrenosum among Crohn's disease patients. Arch Dermatol Res 2024; 316:450. [PMID: 38967803 PMCID: PMC11226561 DOI: 10.1007/s00403-024-03119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 03/28/2024] [Accepted: 04/26/2024] [Indexed: 07/06/2024]
Affiliation(s)
- Camryn Schroeder
- University of Nevada Las Vegas Kirk Kerkorian School of Medicine, 625 Shadow Lane, Las Vegas, NV, 89106, United States.
| | - Renuka Verma
- Department of Internal Medicine, University of Nevada Las Vegas, Las Vegas, NV, United States
| | - Lily Liu
- University of Nevada Las Vegas Kirk Kerkorian School of Medicine, 625 Shadow Lane, Las Vegas, NV, 89106, United States
| | - Hemamalini Sakhthivel
- Department of Internal Medicine, Interfaith Medical Center, Brooklyn, NV, United States
| | - Kyaw Min Tun
- University of Nevada Las Vegas Kirk Kerkorian School of Medicine, 625 Shadow Lane, Las Vegas, NV, 89106, United States
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2
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Mountagui A, Al-Dury S. Pyoderma gangrenosum as an initial presentation of Crohn's colitis. BMJ Case Rep 2023; 16:e256589. [PMID: 38110340 DOI: 10.1136/bcr-2023-256589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Affiliation(s)
- Amin Mountagui
- Department of Medicine, Kungalv Hospital, Kungalv, Sweden
| | - Samer Al-Dury
- Gastroenterology and Hepatology Unit, Sahlgrenska Universitetssjukhuset, Gothenburg, Sweden
- University of Gothenburg, Goteborg, Västra Götaland, Sweden
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3
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Miklusiak K, Miklusiak K, Kaczmarczyk O, Cibor D, Zwolińska-Wcisło M. Ustekinumab in the treatment of acute disseminated pyoderma gangrenosum in a patient with Crohn's disease. Dermatol Reports 2023; 15:9630. [PMID: 37908604 PMCID: PMC10614552 DOI: 10.4081/dr.2023.9630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/03/2023] [Indexed: 11/02/2023] Open
Abstract
Pyoderma gangrenosum (PG) is an auto-inflammatory dermatosis characterized by lesions that often cause ulcers. We present a case of successful ustekinumab treatment for acute general PG in a 31-year-old woman with coexisting Crohn's disease (CD). For a month, the patient suffered from skin ulcers, two of them deep and necrotic; a histopathological examination revealed PG. Treatment included: methylprednisolone, azathioprine, betamethasone, gentamicin and zincic ointments, antiseptic compresses, and adalimumab therapy. Due to resistance to the implemented treatment, the patient was enrolled in a clinical trial that included the administration of an anti-cytokines drug, ustekinumab. Subsequently, a significant reduction was observed in the severity of symptoms of PG with no relapse. The use of ustekinumab in patients with PG who have an inadequate response to current treatment or cannot receive first-line treatment can be considered. This applies especially to patients with accompanying autoimmune diseases such as CD.
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Affiliation(s)
| | - Karol Miklusiak
- Polish Red Cross Maritime Hospital with Oncology Centre, Gdynia
| | - Olga Kaczmarczyk
- Department of Gastroenterology and Hepatology, Jagiellonian University Medical College, Cracow, Poland
| | - Dorota Cibor
- Department of Gastroenterology and Hepatology, Jagiellonian University Medical College, Cracow, Poland
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Jatana S, Ponti AK, Johnson EE, Rebert NA, Smith JL, Fulmer CG, Maytin EV, Achkar JP, Fernandez AP, McDonald C. A novel murine model of pyoderma gangrenosum reveals that inflammatory skin-gut crosstalk is mediated by IL-1β-primed neutrophils. Front Immunol 2023; 14:1148893. [PMID: 37475852 PMCID: PMC10354730 DOI: 10.3389/fimmu.2023.1148893] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/08/2023] [Indexed: 07/22/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a debilitating skin condition often accompanied by inflammatory bowel disease (IBD). Strikingly, ~40% of patients that present with PG have underlying IBD, suggesting shared but unknown mechanisms of pathogenesis. Impeding the development of effective treatments for PG is the absence of an animal model that exhibits features of both skin and gut manifestations. This study describes the development of the first experimental drug-induced mouse model of PG with concomitant intestinal inflammation. Topical application of pyrimidine synthesis inhibitors on wounded mouse skin generates skin ulcers enriched in neutrophil extracellular traps (NETs) as well as pro-inflammatory cellular and soluble mediators mimicking human PG. The mice also develop spontaneous intestinal inflammation demonstrated by histologic damage. Further investigations revealed increased circulating low density IL-1β primed neutrophils that undergo enhanced NETosis at inflamed tissue sites supported by an increase in circulatory citrullinated histone 3, a marker of aberrant NET formation. Granulocyte depletion dampens the intestinal inflammation in this model, further supporting the notion that granulocytes contribute to the skin-gut crosstalk in PG mice. We anticipate that this novel murine PG model will enable researchers to probe common disease mechanisms and identify more effective targets for treatment for PG patients with IBD.
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Affiliation(s)
- Samreen Jatana
- Department of Inflammation & Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - András K. Ponti
- Department of Inflammation & Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Erin E. Johnson
- Department of Inflammation & Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Biology, John Carroll University, University Heights, OH, United States
| | - Nancy A. Rebert
- Department of Inflammation & Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jordyn L. Smith
- Department of Inflammation & Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Clifton G. Fulmer
- Department of Pathology, Pathology & Laboratory Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Edward V. Maytin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Dermatology, Dermatology & Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jean-Paul Achkar
- Department of Inflammation & Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Gastroenterology, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Anthony P. Fernandez
- Department of Pathology, Pathology & Laboratory Medicine, Cleveland Clinic, Cleveland, OH, United States
- Department of Dermatology, Dermatology & Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Christine McDonald
- Department of Inflammation & Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States
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5
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Panganiban RP, Tuan A, Hart M, Pelton M, Mikhail D, Akhtar S, Bogale K, Deiling S, Zhou S, Coates MD, Yochum GS, Koltun W. Pyoderma Gangrenosum Is Associated With Increased Risk of Inflammatory Pouch-Related Complications: A Retrospective Cohort Study. CROHN'S & COLITIS 360 2023; 5:otad024. [PMID: 37663924 PMCID: PMC10474334 DOI: 10.1093/crocol/otad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Indexed: 09/05/2023] Open
Abstract
Background Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis that is a well-established extraintestinal manifestation (EIM) of inflammatory bowel disease. The clinical implications of developing PG in patients with ulcerative colitis (UC) who undergo total proctocolectomy colectomy and ileal pouch anal anastomosis (TPC-IPAA) surgery remain unknown. Methods Study participants were selected from patients enrolled in the Carlino Family Inflammatory Bowel and Colorectal Disease Biobank between 1998 and 2021 with a pre-colectomy diagnosis of UC and who underwent TPC-IPAA surgery. A retrospective study comparing patients with PG and those without PG was performed. The outcomes measured included the development of pouchitis, pouchitis classification, presence of pouch fistula, anal fistula, anal stenosis, and pouch failure. Results In this study, 357 IPAA patients were included, 10 of whom suffered PG. Patients with PG and without PG had similar demographics and clinical characteristics. Both groups had similar rates of pouchitis (80% in PG patients and 64% in patients without PG, P = .504). However, IPAA patients with PG had a higher risk of developing pouch fistula (50% vs 10%, P = .002), anal fistula (40% vs 12%, P = .031), and Crohn's-like disease of the pouch (70% vs 15%, P = .003) compared to patients without PG. Patients who developed PG prior to their first episode of pouchitis were more likely to eventually experience pouch failure (odds ratio: 20.7, 95% confidence interval: 3.9, 110.7, q = 0.003 after false discovery rate adjustment). Conclusions Among UC patients who undergo TPC-IPAA surgery, the development of PG portends poor pouch outcomes and is predictive of pouch failure.
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Affiliation(s)
- Ronaldo Paolo Panganiban
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Penn State Hershey Medical Center, Hershey, PA, USA
- Division of Colorectal Surgery, Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Alyssa Tuan
- College of Medicine, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Maxwell Hart
- Department of Medicine, The University of Arizona College of Medicine Tucson, Tucson, AZ, USA
| | - Mathew Pelton
- Department of Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Daniella Mikhail
- Department of Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Sarah Akhtar
- Department of Internal Medicine, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Kaleb Bogale
- Columbia University Irving Medical Center, New York, NY, USA
| | - Susan Deiling
- Division of Colorectal Surgery, Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Shouhao Zhou
- Division of Biostatistics and Bioinformatics, Department of Public Health Science, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Mathew D Coates
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Gregory S Yochum
- Division of Colorectal Surgery, Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
- Department of Biochemistry and Molecular Biology, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Walter Koltun
- Division of Colorectal Surgery, Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
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Treatment of Pediatric Pyoderma Gangrenosum With Modified Negative Pressure Wound Therapy and Intralesional Corticosteroids: A Case Report. J Wound Ostomy Continence Nurs 2022; 49:488-491. [PMID: 36108234 DOI: 10.1097/won.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a rare ulcerative skin disease; its etiology is unknown, though it is often associated with autoimmune diseases. Pyoderma gangrenosum results in significant morbidity and exquisite pain that affects health-related quality of life. Wound healing is delayed, and patients often experience relapse. Pyoderma gangrenosum is susceptible to pathergy and deterioration with surgical intervention or other trauma; therefore, treatment includes atraumatic wound care, infection management, and local or systemic immunosuppression. CASE We describe the use of modified negative pressure wound therapy (NPWT) with intralesional and topical steroids for the treatment of PG in a 15-year-old female patient with ulcerative colitis and a staged J-pouch ileoanal reconstruction. The patient and her family refused all systemic therapy due to prior steroid-associated weight gain. She was unable to tolerate conscious dressing changes, further complicating the treatment plan. Procedural interventions such as NPWT have been used previously for PG; however, they can cause wound pathergy and subsequent wound deterioration. Modified NPWT in conjunction with topical and intralesional steroids induced wound healing without producing pathergy. CONCLUSION Timely recognition of PG is crucial to appropriate delivery of care. Modified NPWT and localized corticosteroid treatment were key to promoting wound healing in this case of pediatric PG.
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Honma M, Sugawara M, Ueno N, Honma M, Hinooka R, Tani C. Clinical characteristics of peristomal pyoderma gangrenosum: A Single Center Retrospective Observational Study. J Dermatol 2022; 49:1178-1182. [PMID: 35789032 DOI: 10.1111/1346-8138.16504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
Peristomal pyoderma gangrenosum (PPG), a variant of pyoderma gangrenosum, occurs adjacent to intestinal or urinary stomas and are typically seen in patients with active inflammatory bowel diseases (IBD). The present study evaluated 14 cases of PPG among 537 patients that had undergone ostomy surgery at Asahikawa Medical University Hospital from January 2017 to December 2021. The incidence of PPG among ostomy cases was calculated as 1.01 per 100-person-years. The median period from ostomy surgery to PPG onset was 192.5 days (36-1224 days). Significant differences in gender and ostomy subtype were observed in patients with PPG compared to all patients that had undergone ostomy surgery. IBD prevalence was comparable between groups. Topical corticosteroids or tacrolimus were sufficient for controlling PPG lesions in all cases other than one case controlled with oral prednisolone administered for a separate condition. Clinicians should be aware of recent developments in IBD therapies that may modify the risk of developing PPG. The present study results add to current knowledge of the pathogenesis of PPG.
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Affiliation(s)
- Masaru Honma
- Department of Dermatology, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Motoshi Sugawara
- Department of Dermatology, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Naomi Ueno
- Division of Nursing, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Miho Honma
- Division of Nursing, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Ranko Hinooka
- Division of Nursing, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Chikayoshi Tani
- Division of Gastrointestinal Surgery, Department of Surgery, Asahikawa Medical University Hospital, Asahikawa, Japan
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Costescu Strachinaru DI, De Greef A, Marot L, Lerate V, Paridaens MS. Pyoderma gangrenosum induced by transcutaneous electrical nerve stimulation: a case report with literature review. Oxf Med Case Reports 2022; 2022:omac017. [PMID: 35316991 PMCID: PMC8931814 DOI: 10.1093/omcr/omac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Pyoderma gangrenosum (PG) is one of the neutrophilic dermatosis, a heterogenous group of rare inflammatory diseases affecting the skin. It is often associated with systemic diseases such as inflammatory bowel disease, rheumatoid arthritis or hematological malignancies. Classical PG is characterized by painful ulcers with violaceous, undermined border, often developing at sites of injury because of the typical pathergy phenomenon. Because of its polymorphic presentation, misdiagnosis and delayed diagnosis are common. We present a case of PG occurring after transcutaneous electrical nerve stimulation (TENS) in a young female patient with ulcerative colitis. Although electric current has previously been incriminated as a trigger for PG, to the best of our knowledge this is the first case precipitated by TENS. We report a typical case of PG occurring after an unusual stimulus and highlight the challenges that the diagnosis of this relatively rare pathology poses to the clinician.
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Affiliation(s)
| | - Axel De Greef
- Department of Dermatology, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium
| | - Liliane Marot
- Department of Dermatology, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium
- Department of Histopathology, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium
| | - Valérie Lerate
- Burn Unit, Queen Astrid Military Hospital, Brussels, Belgium
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Sedano R, Jairath V. Tofacitinib for the Treatment of Three Immune-mediated Conditions in One Patient: Ulcerative Colitis, Pyoderma Gangrenosum, and Alopecia Areata. Inflamm Bowel Dis 2021; 27:e65. [PMID: 33484124 DOI: 10.1093/ibd/izab005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Rocio Sedano
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Vipul Jairath
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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Hung YT, Le PH, Kuo CJ, Tang YC, Chiou MJ, Chiu CT, Kuo CF, Huang YH. The Temporal Relationships and Associations between Cutaneous Manifestations and Inflammatory Bowel Disease: A Nationwide Population-Based Cohort Study. J Clin Med 2021; 10:1311. [PMID: 33810197 PMCID: PMC8004605 DOI: 10.3390/jcm10061311] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
The temporal relationships between inflammatory bowel disease (IBD)-associated cutaneous manifestations and IBD remain uncertain, with existing evidence mostly from separate cross-sectional studies. We sought to determine the risks of IBD-related dermatologic diseases before and after the diagnosis of IBD. We identified 2847 cases of IBD and 14,235 matched controls from the Taiwan National Health Insurance Research Database between 2003 and 2014. The risks of cutaneous manifestations before and after the diagnosis of IBD were estimated with multivariable-adjusted analyses. At diagnosis, IBD was associated with atopic dermatitis (odds ratio (OR) = 1.61; 95% confidence interval (CI), 1.14-2.28), erythema nodosum (OR = 7.44; 95%CI, 3.75-14.77), aphthous stomatitis (OR = 2.01; 95%CI, 1.72-2.35), polyarteritis nodosa (OR = 5.67; 95%CI, 2.69-11.98), rosacea (OR = 1.67, 95%CI = 1.19-2.35), and cutaneous T cell lymphoma (OR = 21.27; 95%CI, 2.37-191.00). IBD was associated with the subsequent development of pyoderma gangrenosum (hazard ratio (HR) = 17.79; 95%CI, 6.35-49.86), erythema nodosum (HR = 6.54; 95%CI, 2.83-15.13), polyarteritis nodosa (HR = 2.69; 95%CI, 1.05-6.90), hidradenitis suppurativa (HR = 2.48; 95%CI, 1.03-5.97), psoriasis (HR = 2.19; 95%CI, 1.27-3.79), rosacea (HR = 1.92; 95%CI, 1.39-2.65), and aphthous stomatitis (HR = 1.45; 95%CI, 1.22-1.72). This study clarified the associations and temporal relationships between cutaneous manifestations and IBD, highlighting the need for interdisciplinary care in the patient with specific dermatologic diseases presenting with abdominal symptoms, or the IBD patients with cutaneous lesions.
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Affiliation(s)
- Yi-Teng Hung
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan;
| | - Puo-Hsien Le
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan; (P.-H.L.); (C.-J.K.); (C.-T.C.)
- Department of Gastroenterology, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan
| | - Chia-Jung Kuo
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan; (P.-H.L.); (C.-J.K.); (C.-T.C.)
- Department of Gastroenterology, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan
| | - Yu-Chuan Tang
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan; (Y.-C.T.); (M.-J.C.)
| | - Meng-Jiun Chiou
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan; (Y.-C.T.); (M.-J.C.)
| | - Cheng-Tang Chiu
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan; (P.-H.L.); (C.-J.K.); (C.-T.C.)
- Department of Gastroenterology, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan
| | - Chang-Fu Kuo
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan; (P.-H.L.); (C.-J.K.); (C.-T.C.)
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan; (Y.-C.T.); (M.-J.C.)
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan
| | - Yu-Huei Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan;
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan; (P.-H.L.); (C.-J.K.); (C.-T.C.)
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11
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de Sousa Magalhães R, Moreira MJ, Rosa B, Cotter J. Hyperbaric oxygen therapy for refractory pyoderma gangrenosum: a salvage treatment. BMJ Case Rep 2021; 14:14/2/e238638. [PMID: 33602761 PMCID: PMC7896587 DOI: 10.1136/bcr-2020-238638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
A 42-year-old woman with left-side ulcerative colitis (E2 - rectum to splenic flexure) was diagnosed with pyoderma gangrenosum (PG) on a persistent ulcerated wound with peripheral erythema, in the left leg's gemelar surface, associated with tenderness and pain. Due to incomplete response to wound care and oral prednisolone, treatment with infliximab was initiated. As PG remained unresponsive after 12 weeks, the patient was switched to adalimumab with concomitant oral prednisolone. Before the second induction dosage of adalimumab, the refractory PG complicated with a superinfection by Pseudomonas aeruginosa A course of wide spectrum antibiotic therapy, daily wound care including negative pressure bandages and a physiotherapy rehabilitation programme controlled the infection, but the pyoderma persisted non-healed, with visible deep muscle layers and tendons. We proposed hyperbaric oxygen therapy in addition to weekly adalimumab, achieving full remission of the PG and recovering of the left foot's function.
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Affiliation(s)
- Rui de Sousa Magalhães
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal .,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Maria João Moreira
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,ICVS/3B’s, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,ICVS/3B’s, PT Government Associate Laboratory, Guimarães/Braga, Portugal
| | - José Cotter
- Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal,ICVS/3B’s, PT Government Associate Laboratory, Guimarães/Braga, Portugal
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12
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Antonelli E, Bassotti G, Tramontana M, Hansel K, Stingeni L, Ardizzone S, Genovese G, Marzano AV, Maconi G. Dermatological Manifestations in Inflammatory Bowel Diseases. J Clin Med 2021; 10:jcm10020364. [PMID: 33477990 PMCID: PMC7835974 DOI: 10.3390/jcm10020364] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel diseases (IBDs) may be associated with extra-intestinal manifestations. Among these, mucocutaneous manifestations are relatively frequent, often difficult to diagnose and treat, and may complicate the course of the underlying disease. In the present review, a summary of the most relevant literature on the dermatologic manifestations occurring in patients with inflammatory bowel diseases has been reviewed. The following dermatological manifestations associated with IBDs have been identified: (i) specific manifestations with the same histological features of the underlying IBD (occurring only in Crohn's disease); (ii) cutaneous disorders associated with IBDs (such as aphthous stomatitis, erythema nodosum, psoriasis, epidermolysis bullosa acquisita); (iii) reactive mucocutaneous manifestations of IBDs (such as pyoderma gangrenosum, Sweet's syndrome, bowel-associated dermatosis-arthritis syndrome, aseptic abscess ulcers, pyodermatitis-pyostomatitis vegetans, etc.); (iv) mucocutaneous conditions secondary to treatment (including injection site reactions, infusion reactions, paradoxical reactions, eczematous and psoriasis-like reactions, cutaneous infections, and cutaneous malignancies); (v) manifestations due to nutritional malabsorption (such as stomatitis, glossitis, angular cheilitis, pellagra, scurvy, purpura, acrodermatitis enteropathica, phrynoderma, seborrheic-type dermatitis, hair and nail abnormalities). An accurate dermatological examination is essential in all IBD patients, especially in candidates to biologic therapies, in whom drug-induced cutaneous reactions may assume marked clinical relevance.
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Affiliation(s)
| | - Gabrio Bassotti
- Gastroenterology Section, Perugia General Hospital, 06156 Perugia, Italy;
- Gastroenterology & Hepatology Section, Department of Medicine, University of Perugia, 06156 Perugia, Italy
- Correspondence:
| | - Marta Tramontana
- Dermatology Section, Department of Medicine, University of Perugia, 06156 Perugia, Italy; (M.T.); (K.H.); (L.S.)
| | - Katharina Hansel
- Dermatology Section, Department of Medicine, University of Perugia, 06156 Perugia, Italy; (M.T.); (K.H.); (L.S.)
| | - Luca Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, 06156 Perugia, Italy; (M.T.); (K.H.); (L.S.)
| | - Sandro Ardizzone
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, “L.Sacco” Hospital, 20157 Milano, Italy; (S.A.); (G.M.)
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCSS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (G.G.); (A.V.M.)
- Department of Pathophysiology and Transplantation, University of Milano, 20122 Milano, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCSS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (G.G.); (A.V.M.)
- Department of Pathophysiology and Transplantation, University of Milano, 20122 Milano, Italy
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, “L.Sacco” Hospital, 20157 Milano, Italy; (S.A.); (G.M.)
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13
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Hanzel J, Ma C, Casteele NV, Khanna R, Jairath V, Feagan BG. Vedolizumab and Extraintestinal Manifestations in Inflammatory Bowel Disease. Drugs 2021; 81:333-347. [PMID: 33400241 DOI: 10.1007/s40265-020-01460-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In Crohn's disease and ulcerative colitis, inflammation is not limited to the digestive tract. Extraintestinal manifestations (EIMs), which affect up to 50% of patients, can substantially impair quality of life. EIMs may parallel luminal disease activity or have an independent course. They most commonly involve the musculoskeletal system (e.g., peripheral or axial arthritis) and skin (e.g., erythema nodosum and pyoderma gangrenosum). Less commonly, the hepatobiliary tract (e.g., primary sclerosing cholangitis [PSC]) and the eye (e.g., episcleritis, scleritis, and uveitis) are involved. Although the pathophysiology of EIMs is poorly understood, they are likely either manifestations of a primary systemic immune disease with variable expression amongst organs, or secondary phenomena to bowel inflammation. Additional pathophysiologic mechanisms may include aberrant lymphocyte homing mediated by ectopic expression of gut-specific chemokines and adhesion molecules, cross-reactivity between microbial and self-antigens, autoantibodies against epitopes shared by the intestine and extraintestinal tissues, elevated serum concentrations of cytokines, and alterations in innate immunity. Many EIMs independent of intestinal disease activity can be successfully treated with tumor necrosis factor (TNF) antagonists. The efficacy of vedolizumab-a monoclonal antibody targeting the α4β7 integrin-for the treatment of EIMs is uncertain, but data are emerging from post hoc analyses of randomized controlled trials, prospective and retrospective cohort studies, and case series. Vedolizumab may be effective in treating EIMs related to luminal disease activity (e.g., type 1 peripheral arthritis and erythema nodosum) but has not shown biochemical improvement in PSC. Its postulated role in the development of de novo EIMs is heavily confounded by the high proportion of patients previously exposed to TNF antagonists; new EIMs could result from TNF antagonist treatment cessation rather than being caused by vedolizumab. A common limitation of clinical studies is the lack of multidisciplinary involvement in the diagnosis and monitoring of EIMs, which may lead to misdiagnosis and overreporting. Future studies should rigorously measure EIMs in parallel with objective measures of luminal disease activity to provide more robust data on the relative efficacy of new drugs, especially as increasing numbers of gut-selective compounds enter clinical development.
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Affiliation(s)
- Jurij Hanzel
- Department of Gastroenterology, University Medical Center Ljubljana, Ljubljana, Slovenia.,Alimentiv, #200, 100 Dundas Street, London, N6A 5B6, ON, Canada.,, Hullenbergweg 278-308, 1101 BV, Amsterdam, The Netherlands
| | - Christopher Ma
- Alimentiv, #200, 100 Dundas Street, London, N6A 5B6, ON, Canada.,Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, 6D61 Teaching Research Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Niels Vande Casteele
- Alimentiv, #200, 100 Dundas Street, London, N6A 5B6, ON, Canada.,Department of Medicine, University of California San Diego, 9500 Gilman Drive #0956, La Jolla, CA, 92093, USA
| | - Reena Khanna
- Division of Gastroenterology, University of Western Ontario, 1151 Richmond Street, London, N6A 2K7, ON, Canada
| | - Vipul Jairath
- Alimentiv, #200, 100 Dundas Street, London, N6A 5B6, ON, Canada.,Division of Gastroenterology, University of Western Ontario, 1151 Richmond Street, London, N6A 2K7, ON, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada
| | - Brian G Feagan
- Alimentiv, #200, 100 Dundas Street, London, N6A 5B6, ON, Canada. .,Division of Gastroenterology, University of Western Ontario, 1151 Richmond Street, London, N6A 2K7, ON, Canada. .,Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada. .,Department of Medicine, University of Western Ontario, London, ON, Canada.
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14
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Salmón Olavarría P, Rubio Iturria S, Nantes Castillejo O. Tofacitinib, useful option for the treatment of pyoderma gangrenosum in an ulcerative colitis patient. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:733-734. [DOI: 10.17235/reed.2021.7977/2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Treatment of Pyoderma Gangrenosum in Pediatric Inflammatory Bowel Disease. ACTA ACUST UNITED AC 2020; 1:e008. [DOI: 10.1097/pg9.0000000000000008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/03/2020] [Indexed: 11/26/2022]
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16
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Mikail M, Wilson A. Infliximab treatment for large, multifocal, abdominal pyoderma gangrenosum associated with ulcerative colitis: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20964113. [PMID: 33149915 PMCID: PMC7585984 DOI: 10.1177/2050313x20964113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/15/2020] [Indexed: 11/15/2022] Open
Abstract
Pyoderma gangrenosum is an uncommon neutrophilic dermatosis that is highly associated with pathergy in the setting of trauma or surgery, systemic disease, or may be idiopathic. Herein, we present the case of a 68-year-old female with ulcerative colitis who underwent a subtotal colectomy with an end-ileostomy and presented post-operatively with large, multifocal pyoderma gangrenosum at two abdominal sites. She was managed with intralesional triamcinolone injections and high-dose systemic steroids and was transitioned to IV infliximab. Our case report illustrates the role of infliximab in the treatment of complicated multifocal pyoderma gangrenosum and contemplates the impact of systemic infliximab exposure.
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Affiliation(s)
- Maria Mikail
- Schulich School of Medicine & Dentistry, Health Sciences Addition, Western University, London, ON, Canada
| | - Aze Wilson
- Department of Medicine, Division of Gastroenterology, Western University, London, ON, Canada.,Department of Medicine, Division of Clinical Pharmacology, Western University, London, ON, Canada.,Department of Physiology & Pharmacology, Western University, London, ON, Canada
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17
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López González J, Lázaro Sáez M, Moreno Moraleda I, Hernández Martínez Á. Pyoderma gangrenosum solved by ustekinumab therapy. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 44:299-300. [PMID: 33069432 DOI: 10.1016/j.gastrohep.2020.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/01/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- José López González
- Unidad de Gestión Clínica del Aparato Digestivo, Hospital Universitario Torrecárdenas, Almería, España.
| | - Marta Lázaro Sáez
- Unidad de Gestión Clínica del Aparato Digestivo, Hospital Universitario Torrecárdenas, Almería, España
| | - Isabel Moreno Moraleda
- Unidad de Gestión Clínica del Aparato Digestivo, Hospital Universitario Torrecárdenas, Almería, España
| | - Álvaro Hernández Martínez
- Unidad de Gestión Clínica del Aparato Digestivo, Hospital Universitario Torrecárdenas, Almería, España
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18
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Marotto D, Atzeni F, Ardizzone S, Monteleone G, Giorgi V, Sarzi-Puttini P. Extra-intestinal manifestations of inflammatory bowel diseases. Pharmacol Res 2020; 161:105206. [PMID: 32998068 DOI: 10.1016/j.phrs.2020.105206] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 01/01/2023]
Abstract
Inflammatory bowel disease (IBDs), including the two main subtypes of Crohn's disease and ulcerative colitis, not only affects the gastrointestinal system, but also has a wide range of extra-intestinal manifestations (EIMs) that are major sources of morbidity and disability, and therefore represent what can be considered a real syndrome. The pathogenetic mechanisms underlying these EIMs are unknown, but some may share a common pathogenesis with IBD and others may be due to IBD treatment. The aim of this review is to examine our current knowledge of IBD EIMs and their treatment.
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Affiliation(s)
- Daniela Marotto
- Rheumatology Unit, P. Dettori Hospital, AST Sardegna, Tempio Pausania, Italy.
| | - Fabiola Atzeni
- Rheumatology Unit, University of Messina, Messina, Italy
| | - Sandro Ardizzone
- Gastroenterology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, Milan University School of Medicine, Milan, Italy
| | - Giovanni Monteleone
- Department of Systems Medicine, University of Rome "TOR VERGATA", Rome, Italy
| | - Valeria Giorgi
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, Milan University School of Medicine, Milan, Italy
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, Milan University School of Medicine, Milan, Italy
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19
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Affiliation(s)
- F-C Liu
- Division of Gastroenterology, Department of Internal Medicine
| | - N-T Liu
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Chenggong Rd., Neihu District, Taipei 11490, Taiwan
| | - T-Y Huang
- Division of Gastroenterology, Department of Internal Medicine
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20
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Liu FC, Huang TY. Early and accurate diagnosis of pyoderma gangrenosum. QJM 2020; 113:593. [PMID: 32294196 DOI: 10.1093/qjmed/hcaa130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- F-C Liu
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei 11467, Taiwan
| | - T-Y Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei 11467, Taiwan
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21
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Wang J, Prenner J, Wang W, Sakuraba A, Hyman N, Dalal S, Hurst R, Cohen RD, Umanskiy K, Shogan BD, Alpert L, Rubin DT, Colwell J, Pekow J. Risk factors and treatment outcomes of peristomal pyoderma gangrenosum in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2020; 51:1365-1372. [PMID: 32383278 DOI: 10.1111/apt.15766] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/12/2020] [Accepted: 04/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Insufficient data exist for peristomal pyoderma gangrenosum (PPG), which primarily affects patients with inflammatory bowel disease (IBD). AIMS To evaluate the risk factors and treatment response of PPG in IBD patients in a real-life cohort. METHODS Cases of PPG were identified retrospectively using ICD-9/10 codes in patients with IBD who had an ostomy at a tertiary care centre. Disease-specific characteristics were compared between groups with and without PPG, and response to therapy was evaluated in patients with PPG. RESULTS The cohort included 41 IBD patients with PPG and 123 IBD controls with an ostomy who never developed PPG. Patients with PPG were more likely to be female (76% vs 51%, P = 0.006), had higher BMIs (29.78 ± 0.89 vs 23.53 ± 0.51, P < 0.0001) and had increased usage of pouch belts (97% vs 71%, P = 0.0008) compared to controls. There were no differences in age at surgery (41.76 ± 2.60 vs 43.49 ± 1.50, P = 0.57) or IBD diagnosis (63% vs 54% Crohn's disease, P = 0.28) between PPG and controls. 85% of PPG patients achieved complete resolution with different treatments, including surgery. Complete resolution with topical corticosteroids and calcineurin inhibitors alone were low (14% and 13% respectively). Higher rates of complete resolution were reported with anti-tumour necrosis factor (TNF) agents (63%) and surgical interventions (80%). CONCLUSIONS Female gender, higher BMI and pouch belts were associated with increased risk of developing PPG. Most PPG cases resolved after treatment with the highest rates of complete resolution seen with anti-TNF agents and surgical intervention.
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Affiliation(s)
- Jingzhou Wang
- Department of Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Joshua Prenner
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Wenfei Wang
- Department of Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Atsushi Sakuraba
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Neil Hyman
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Sushila Dalal
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Roger Hurst
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Russell D Cohen
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | | | | | - Lindsay Alpert
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - David T Rubin
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Janice Colwell
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Joel Pekow
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
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22
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Sousa M, Campos MA, Sousa AC, Lopes J, Rodrigues A, Carvalho J. Extensive Refractory Perineal Pyoderma Gangrenosum Treated with Infliximab, Fecal Diversion, and Negative-Pressure Wound Therapy. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 27:128-131. [PMID: 32266311 DOI: 10.1159/000502982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/27/2019] [Indexed: 01/05/2023]
Abstract
Background Pyoderma gangrenosum (PG) is a rare and difficult-to-diagnose disease that often associates with inflammatory bowel disease. Case We present a case of a 57-year-old female with ulcerative colitis receiving 5-ASA who presented with rapidly progressive ulcers in the right foot and on the inside of the thigh, extending from the left large vaginal lip to the perianal area, compatible with PG. She was initially treated with corticosteroids with no response. After multidisciplinary consultation, it was decided to initiate in-fliximab 5 mg/kg, and to perform ileostomy for fecal diversion and negative-pressure wound therapy. The patient presented with marked improvement of the lesions, being discharged after 2 months and demonstrating almost complete resolution of the lesions within 4 months. Conclusion Due to the rarity of PG, there is no evidence of the optimal management. The role of surgery is controversial as PG lesions can demonstrate pathergy and theoretically could worsen with surgical intervention. In this case it was decided based on the extent of the lesions and the experience in other septic/ulcerative perianal conditions.
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Affiliation(s)
- Mafalda Sousa
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Manuel António Campos
- Dermatology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Ana Cristina Sousa
- Dermatology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Jorge Lopes
- Dermatology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Adélia Rodrigues
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - João Carvalho
- Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
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23
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Gregory MH, Ciorba MA, Deepak P, Christophi GP. Successful Treatment of Pyoderma Gangrenosum with Concomitant Tofacitinib and Infliximab. Inflamm Bowel Dis 2019; 25:e87-e88. [PMID: 30753456 DOI: 10.1093/ibd/izz015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/19/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Martin H Gregory
- Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew A Ciorba
- Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri
| | - Parakkal Deepak
- Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri
| | - George P Christophi
- Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, Missouri
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24
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Kochar B, Herfarth N, Mamie C, Navarini AA, Scharl M, Herfarth HH. Tofacitinib for the Treatment of Pyoderma Gangrenosum. Clin Gastroenterol Hepatol 2019; 17:991-993. [PMID: 30404036 DOI: 10.1016/j.cgh.2018.10.047] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/23/2018] [Accepted: 10/26/2018] [Indexed: 02/07/2023]
Abstract
Pyoderma gangrenosum (PG) is a difficult-to-treat inflammatory skin condition that affects inflammatory bowel disease (IBD) patients. There is no standardized approach for PG treatment.1 We report the results of 3 patients with Crohn's disease (CD) and refractory PG who had failed several therapies with biologics and were started on tofacitinib for severe inflammatory arthritis with resolution of their PG.
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Affiliation(s)
- Bharati Kochar
- Multidisciplinary Center for Inflammatory Bowel Disease, University of North Carolina, Chapel Hill, North Carolina; Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina
| | - Neel Herfarth
- Division of Gastroenterology and Hepatology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Céline Mamie
- Division of Gastroenterology and Hepatology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Alexander A Navarini
- Department of Dermatology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michael Scharl
- Division of Gastroenterology and Hepatology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hans H Herfarth
- Multidisciplinary Center for Inflammatory Bowel Disease, University of North Carolina, Chapel Hill, North Carolina; Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina.
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25
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Sharma Y, Humphreys K, Thompson C. Extensive abdominal wall ulceration as a late manifestation of antiphospholipid syndrome: a case report. J Med Case Rep 2018; 12:226. [PMID: 30103822 PMCID: PMC6090673 DOI: 10.1186/s13256-018-1753-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antiphospholipid syndrome is an autoimmune disorder characterized by the presence of antiphospholipid antibodies and commonly presents with vascular thromboembolic phenomena, thrombocytopenia, and obstetric complications. Antiphospholipid syndrome can be classified as either primary or secondary to other connective tissue diseases. Dermatologic manifestations are common; however, non-vasculitic skin ulceration is an uncommon manifestation of antiphospholipid syndrome with limited treatment options. CASE PRESENTATION In this paper we report the case of a 58-year-old white woman who developed necrotic abdominal wall ulcers 27 years after a diagnosis of secondary antiphospholipid syndrome associated with systemic lupus erythematosus. The ulcers developed despite our patient being on therapeutic anticoagulation with warfarin and were resistant to further increases in the intensity of anticoagulation. Management was further complicated due to reluctance on the part of our patient to switch over to injectable heparin. CONCLUSIONS This case highlights a rare late dermatologic presentation of antiphospholipid syndrome, which responded poorly to conventional anticoagulation with warfarin. Current management is limited to experimental therapies and the role of newer anticoagulants is still unknown.
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Affiliation(s)
- Yogesh Sharma
- Department of General Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, South Australia, Australia. .,College of Medicine and Public Health, Flinders University, Flinders Drive, Bedford Park, Adelaide, South Australia, Australia.
| | - Karen Humphreys
- Karen Humphreys, Flinders University, Flinders Drive, Bedford Park, Adelaide, South Australia, Australia
| | - Campbell Thompson
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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