[Pyoderma gangrenosum treated successfully with visilizumab in patients with ulcerative colitis]

Pyoderma gangrenosum is a misleading designation for an idiopathic ulcerating cutaneous disease. The activity of pyoderma gangrenosum may or may not follow the activity of the inflammatory bowel disease. Visilizumab (Nuvion, PDL Bio Pharma, USA), a humanized IgG2 monoclonal antibody that binds to the human CD3 epsilon chain expressed on human T cells, induces the rapid production of selective chemokines, and reduces the CXCR3-mediated chemotaxis of the resting peripheral blood lymphocytes. In activated, but not resting T cells, visilizumab leads to rapid apoptosis.

During a period of 20 years, a 40-year-old male took part in more than 30 courses of treatment for a dermatological condition misdiagnosed as crural eczema, mycosis and infected wounds. This ulcerative process was very severe in both crural regions. Ulcerative colitis was diagnosed a decade ago. He has been steroid-dependent since 1997. In 2005, pyoderma gangrenosum was diagnosed. In 2006, the patient participated in the visilizumab study and received 2x375 mcg study drug (5 mcg/kg/dose) intravenously. Six months after visilizumab administration, his leg ulcers healed. After the administration of visilizumab, pyoderma gangrenosum had not relapsed.

In this severe pyoderma case, visilizumab also treated the skin disease. Although the colitis later worsened, the pyoderma gangrenosum has not recurred to date in this steroid-dependent patient. Pyoderma gangrenosum may be a T cell-mediated disease. The fact that biological therapy proved dramatically effective in this patient may suggest the use of these agents as first line of therapy in such cases.