Myelodysplastic syndrome with neutrophilic dermatosis successfully treated with azacitidine

A 66-year-old male underwent prednisolone (PSL) therapy of 13 mg/day for rheumatoid arthritis (RA). Antiphospholipid antibody syndrome, neutrophilic dermatosis (ND), and myelodysplastic syndrome (MDS) developed. Treatment of MDS required red cell concentrate transfusion, and second courses of azacitidine therapy (75 mg/m² daily, intravenous injection for 7 consecutive days) led to hematologic remission. Furthermore, ND improved early after the start of azacitidine therapy, making it possible to decrease the dose of PSL. After 12th courses of azacitidine therapy, treatment was discontinued and the long-term remission of MDS and ND has been maintained. During the course, the level of matrix metalloproteinase-3, as a marker of RA, also decreased. There are few case reports of MDS in which azacitidine was effective for autoimmune diseases, including ND. We report the present case.