title: Multimodal therapy of idiopathic pyoderma gangrenosum.
abstract: A 13-year old girl was admitted to the University of California Davis Medical Center for evaluation and treatment of cutaneous bullae and ulcerations over her lower extremities that were refractory to antibiotic therapy and incision and drainage. Her disease continued to worsen with the appearance of multiple new bullae and the progression of old ones into deep ulcers with undermined borders. Biopsy revealed a neutrophilic dermatosis and diagnostic work-up was negative for infectious or autoimmune etiologies. Given her clinical presentation, biopsy results, and negative work-up, a diagnosis of pyoderma gangrenosum (PG) was made and she was started on immunosuppressive medications. The patient was started on a multidrug regimen of prednisone and cyclosporine but remission was not achieved until the addition of adalimumab. After the inflammatory component of her disease was under control, wound care measures were maximized to promote ulcer healing. Wound care measures included compression and debridement. Upon complete closure of all wounds she was successfully transitioned to mycophenolate mofetil monotherapy for maintenance therapy. This case emphasizes the need for combinational therapy to successfully treat severe cases of PG, which are often refractory to monotherapy with prednisone or cyclosporine. It also highlights the importance of appropriate wound care to achieve complete ulcer healing.
authors.forename: Victoria
authors.initials: V
authors.lastname: Sharon
authors.forename: Barbara
authors.initials: B
authors.lastname: Burrall
authors.forename: Forum
authors.initials: F
authors.lastname: Patel
authors.forename: Yong
authors.initials: Y
authors.lastname: He
authors.forename: Thomas
authors.initials: T
authors.lastname: Konia
authors.forename: Itzel Bustos
authors.initials: IB
authors.lastname: Villalobos
authors.affiliation: University of California, Davis.
authors.forename: Emanual
authors.initials: E
authors.lastname: Maverakis
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001706:Biopsy; D003131:Combined Modality Therapy; D016572:Cyclosporine / Q000627:therapeutic use; D003646:Debridement; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007866:Leg; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010808:Physical Examination; D011241:Prednisone / Q000627:therapeutic use; D017511:Pyoderma Gangrenosum / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000068879:Adalimumab; D009173:Mycophenolic Acid; D011241:Prednisone