Infliximab-induced Remission of Postoperative Pyoderma Gangrenosum: A Case Report and Literature Review

Area of Science:

• Dermatology
• Immunology

Background:

• Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis causing painful ulcers.
• Postoperative PG (PPG) arises at surgical sites due to pathergy, often misdiagnosed.
• Delayed diagnosis of PPG can lead to ineffective treatments and surgical interventions.

Purpose of the Study:

• To report a case of refractory postoperative pyoderma gangrenosum.
• To evaluate the efficacy of infliximab in treating severe PPG.
• To review literature on TNF-α inhibitors for PPG management.

Main Methods:

• A 69-year-old male patient presented with extensive ulcerative lesions post-surgery for chronic venous insufficiency.
• Initial treatments included surgical debridements and antibiotics without improvement.
• Diagnosis of PPG was confirmed, and treatment with corticosteroids was initiated, followed by infliximab.

Main Results:

• Systemic corticosteroids provided partial improvement for the patient's PPG.
• Infliximab treatment led to complete healing of the ulcerative lesions.
• The patient achieved remission with infliximab and discontinuation of immunosuppressants.

Conclusions:

• This case underscores the importance of recognizing PPG in non-healing surgical ulcers.
• Infliximab proved effective as a steroid-sparing therapy for severe PPG.
• TNF-α inhibitors represent a viable treatment for refractory PPG.