[Pyoderma gangrenosum with lung involvement treated with infliximab]

Area of Science:

• Dermatology
• Pulmonology
• Gastroenterology

Background:

• Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis.
• It is frequently associated with systemic conditions, notably chronic inflammatory bowel diseases (IBD).
• Extracutaneous manifestations are common, with pulmonary involvement being the most frequent.

Observation:

• A case of PG with concurrent skin and lung involvement is presented.
• The patient had severe ulcerative colitis (UC) and was treated with high-dose corticosteroids.
• Lung involvement was identified before initiating anti-TNFα therapy.

Findings:

• Infliximab treatment led to rapid improvement in both pulmonary and cutaneous lesions.
• The patient's condition worsened under corticosteroid therapy, indicating a need for alternative treatment.
• Simultaneous skin and lung lesions suggestive of abscesses warrant suspicion of visceral involvement.

Implications:

• This case underscores the importance of considering visceral involvement in patients with simultaneous cutaneous and pulmonary PG lesions.
• While corticosteroids are a first-line treatment, anti-TNFα therapy, such as infliximab, can be effective in refractory cases or those with significant systemic disease.
• Early diagnosis and appropriate management are crucial for improving outcomes in complex PG cases.