The use of high-dose immunoglobulin in the treatment of pyoderma gangrenosum.
BACKGROUND
Immunosuppressive medications such as corticosteroids and cyclosporin are the most commonly employed therapies in pyoderma gangrenosum. We describe a patient with multiple ulcers of pyoderma gangrenosum on the lower extremities in whom immunosuppressive therapy caused serious side effects and had to be discontinued but who was subsequently treated successfully with high dose intravenous immunoglobulin (IVIG).


METHODS
IVIG was given intravenously at a dose of 400 mg/kg per day for 5 consecutive days. After 1 week there was an arrest in the progression of the ulcers and a marked reduction in pain. Two weeks later clinical improvement of the ulcers was observed. Subsequently, IVIG was given at a dose of 1 g/kg per day for 2 consecutive days.


RESULTS
The treatment induced a dramatic clinical improvement of one ulcer and healing of the others. Side effects were minimal and well tolerated, and consisted of chills and a slight fever, which resolved with the administration of acetaminophen.


CONCLUSIONS
We feel that IVIG can be used in patients with pyoderma gangrenosum in whom conventional therapies are ineffective or produce serious side effects.
Hagman
J H
JH
University of Rome 'Tor Vergata', Department of Dermatology, Rome, Italy.
Carrozzo
A M
AM
Campione
E
E
Romanelli
P
P
Chimenti
S
S
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007871:Leg Ulcer / Q000188:drug therapy*; D008297:Male; D017511:Pyoderma Gangrenosum / Q000188:drug therapy*
D016756:Immunoglobulins, Intravenous