title: Disseminated refractory pyoderma gangraenosum during an ulcerative colitis flare. Treatment with infliximab.
abstract: BACKGROUND
  Pyoderma gangraenosum is an immune-mediated, inflammatory, neutrophilic dermatosis of unknown etiology, which represents one of the extraintestinal manifestations of inflammatory bowel disease. It is a rare disease that occurs in less than 1% of patients with inflammatory bowel disease and with the same ratio in patients with Crohn's disease and ulcerative colitis.
  
  
  METHODS
  A 36-year-old woman was diagnosed with ulcerative colitis 6 years before admission to our dermatology department with an acute disseminated pyoderma gangraenosum with mucosal involvement, during a flare of ulcerative colitis. Disease progression was interrupted by intravenous administration of the tumor necrosis factor-α inhibitor infliximab at 5 mg/kg at weeks 0, 2, and 6 (1st cycle) and every 8 weeks thereafter. Improvement of intestinal, skin and oral manifestations was evident already after the 1st cycle of treatment and has been maintained since (at least 16 months).
  
  
  CONCLUSIONS
  This case report is one of very few on disseminated pyoderma gangraenosum with oral involvement complicating ulcerative colitis, where infliximab was shown to have a rapid efficacy on skin, mucosal and bowel symptoms.
authors.affiliation: Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany;
authors.forename: Vasiliki A
authors.initials: VA
authors.lastname: Zampeli
authors.affiliation: Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany;
authors.forename: Undine
authors.initials: U
authors.lastname: Lippert
authors.affiliation: Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany;
authors.forename: Georgios
authors.initials: G
authors.lastname: Nikolakis
authors.affiliation: Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany;
authors.forename: Evgenia
authors.initials: E
authors.lastname: Makrantonaki
authors.affiliation: Division of Evidenced Based Dermatology, Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany;
authors.forename: Thrasivoulos G
authors.initials: TG
authors.lastname: Tzellos
authors.affiliation: Institute of Pathology, Dessau Medical Center, Dessau, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Krause
authors.affiliation: Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany; ; Division of Evidenced Based Dermatology, Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany;
authors.forename: Christos C
authors.initials: CC
authors.lastname: Zouboulis
keywords: TNF-alpha; inflammatory bowel disease; mesalazine mucous membranes; pyoderma gangrenosum