Successful renal transplantation for a patient with pyoderma gangrenosum.
Pyoderma gangrenosum (PG), a rare skin disease of unknown etiology, forms intractable skin ulcers at surgical or traumatic sites. This case is a 40-year-old woman with PG who experienced end-stage renal disease due to type 1 diabetes mellitus. Arteriovenous fistula (AVF) creation and peritoneal dialysis introduction were considered to be difficult, because this patient had a history of developing intractable aseptic ulcers at surgical sites. Therefore, she continued hemodialysis via a temporary catheter. With frequent catheter exchange, there was stenosis of both the femoral veins and the internal jugular vein. Therefore, a hemodialysis catheter that could be used for the long term was inserted into the left jugular vein as a final site. To prevent the patient not being able to continue hemodialysis, we performed a kidney transplantation to save her life. We performed a blood type-compatible, living donor kidney transplantation after confirming the absence of active skin lesions. The 69-year-old donor was her mother. Induction immunotherapy started with tacrolimus, mycophenolate mofetil, steroids, and basiliximab. Intravenous pulses of methylprednisolone were performed to prevent ulceration of the surgical site on days 0-2 (500 mg/d). The postoperative course was excellent. After the operation, ulceration of the surgical site was never observed. The serum creatinine value was 0.87 mg/dL at 6 months. To our knowledge, renal transplantations for a patient with PG has not been previously reported.
Fujita
T
T
Department of Urology, Chukyo Hospital, Nagoya, Aichi, Japan.
Kinukawa
T
T
Hattori
R
R
Suzuki
A
A
Ishida
S
S
Kimura
T
T
Kato
M
M
Tsuji
Y
Y
Kodera
M
M
Mihara
K
K
D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D019520:Living Donors; D008297:Male; D009035:Mothers; D017511:Pyoderma Gangrenosum / Q000601:surgery* / Q000628:therapy; D006435:Renal Dialysis; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D003404:Creatinine