It's not always an infection: Pyoderma gangrenosum of the urogenital tract in two patients with multiple sclerosis treated with rituximab

• Published in: Multiple sclerosis and related disorders 2023-02, Vol.70, p.104483, Article 104483
• Main Authors: Parrotta, Erica, Kopinsky, Hannah, Abate, Jennifer, Ryerson, Lana Zhovtis, Krupp, Lauren B.
• Format: Article
• Language: English
• Subjects: Disease modifying therapies – risk management; Female; Humans; Immunoglobulins, Intravenous - therapeutic use; Male; Multiple Sclerosis - drug therapy; Multiple Sclerosis, Relapsing-Remitting - drug therapy; Pyoderma Gangrenosum - diagnosis; Pyoderma Gangrenosum - drug therapy; Pyoderma Gangrenosum - etiology; Rituximab - therapeutic use
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2022.104483

B-cell depleting therapies such as rituximab and ocrelizumab are widely used for the treatment of Multiple Sclerosis but have increased risks of adverse reactions compared to earlier MS therapies. One rarely reported reaction is pyoderma gangrenosum (PG), an inflammatory, ulcerative, skin disease of unclear etiology. Here we describe a male and female patient, each with Relapsing-Remitting Multiple Sclerosis, and both of whom developed PG while on rituximab. Both PG diagnoses were supported by persistent fever, biopsy reports of sterile neutrophilia, and leukocytosis in the absence of an identifiable infectious agent. The diagnoses were further confirmed by dramatic clinical improvement following initiation of high dose steroids and intravenous immunoglobulins, and discontinuation of rituximab.