Pyoderma gangrenosum outside the context of inflammatory bowel disease treated successfully with infliximab


V. J. Swale, Department of Dermatology, Royal Free Hospital, Pond Street, London, NW3 2QG, UK. Tel.: +44 (0)20 7794 0500 ext 3509. Fax: +44 (0)20 7830 2247.


A 63-year-old man with chronic lymphocytic leukaemia developed pyoderma gangrenosum following minor trauma to the leg. He required intensive inpatient management with a multitude of treatments including larval therapy, surgical debridement, ciclosporin, methotrexate, thalidomide, pulsed intravenous methylprednisolone and high-dose intravenous immunoglobulin, clofazamine and high dose oral corticosteroids, none of which were helpful. Treatment complications included steroid-induced diabetes, Cushing's syndrome and perforated peptic ulcer. The pyoderma remained refractory to treatment and continued to extend until he received intravenous infliximab 5 mg/kg at weeks 0, 2 and 6.