title: Pyoderma gangrenosum treated with high-dose intravenous immunoglobulins: Two cases and review of the literature.
abstract: Pyoderma gangrenosum (PG) is a neutrophilic skin disease commonly treated with immunosuppressants. High-dose intravenous immunoglobulins are used to treat a range of inflammatory diseases, but we found only five reports of the use of high-dose intravenous immunoglobulins in the treatment of PG. We report on two patients with PG for whom immunosuppressants could not be prescribed and who were treated with high-dose intravenous immunoglobulins. Case 1 was a 58-year-old man who presented with a 6-year history of PG. He was initially treated with prednisone. The 20 mg/day dosage of prednisone could not be reduced and treatment had to be discontinued after 1 year because of serious adverse effects. Minocycline treatment led to improvement but had to be discontinued after 6 years because of facial skin hyperpigmentation. Case 2 was a 66-year-old man who presented with a 3-year history of PG. Different therapeutic procedures for PG (prednisone, topical tacrolimus or betamethasone) had failed. High-dose intravenous immunoglobulins were administered monthly at a dose of 2 g/kg for 6 months. The treatment induced stabilisation of the disease and made it possible to reduce corticosteroid use in both patients. These cases show that high-dose intravenous immunoglobulins represent a therapeutic alternative for PG, but the efficacy of this treatment should be confirmed in further studies.
authors.affiliation: Department of Dermatology, Pontchaillou Hospital, Rennes, France. nicolas.meyer@chu-rennes.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meyer
authors.forename: Valérie
authors.initials: V
authors.lastname: Ferraro
authors.forename: Marie-Henriette
authors.initials: MH
authors.lastname: Mignard
authors.forename: Henri
authors.initials: H
authors.lastname: Adamski
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Chevrant-Breton
mesh_terms: D000368:Aged; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017511:Pyoderma Gangrenosum / Q000188:drug therapy*
chemical_list: D016756:Immunoglobulins, Intravenous