Intravenous cyclosporine in refractory pyoderma gangrenosum complicating inflammatory bowel disease

• Published in: Inflammatory bowel diseases 2001-02, Vol.7 (1), p.1-7
• Main Authors: Friedman, Sonia, Marion, James F., Scherl, Ellen, Rubin, Peter H., Present, Daniel H.
• Format: Article
• Language: English
• Subjects: 6-Mercaptopurine; Adrenal Cortex Hormones - pharmacology; Adult; Aged; Antibiotics; azathioprine; Crohn's disease; Cyclosporine - administration & dosage; Cyclosporine - pharmacology; Cyclosporins; Drug Resistance; Female; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - pharmacology; Inflammatory bowel disease; Inflammatory bowel diseases; Inflammatory Bowel Diseases - complications; Infusions, Intravenous; Intestine; Intravenous administration; Intravenous cyclosporine; Male; Mercaptopurine - administration & dosage; Middle Aged; Pyoderma; Pyoderma gangrenosum; Pyoderma Gangrenosum - drug therapy; Pyoderma Gangrenosum - pathology; Remission; Retrospective Studies; Steroid hormones; Toxicity; Treatment Outcome; Ulcerative colitis
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1097/00054725-200102000-00001

Background Pyoderma gangrenosum complicates inflammatory bowel disease in 2–3% of patients and often fails to respond to antibiotics, steroids, surgical debridement or even colectomy. Methods We performed a retrospective chart analysis of 11 consecutive steroid‐refractory pyoderma patients (5 ulcerative colitis, 6 Crohn's disease) referred to our practice and then treated with intravenous cyclosporine. Pyoderma gangrenosum was present on the extremities in 10 patients, the face in 2, and stomas in 2. At initiation of intravenous cyclosporine, bowel activity was moderate in 3 patients, mild in 4, and inactive in 4. All patients received intravenous cyclosporine at a dose of 4 mg/kg/d for 7–22 days. They were discharged on oral cyclosporine at a dose of 4–7 mg/kg/d. Results All 11 patients had closure of their pyoderma with a mean time to response of 4.5 days and a mean time to closure of 1.4 months. All seven patients with bowel activity went into remission. Nine patients were able to discontinue steroids, and nine were maintained on 6‐mercaptopurine or azathioprine. One patient who could not tolerate 6‐mercaptopurine had a recurrence of pyoderma. No patient experienced significant toxicity. Conclusion Intravenous cyclosporine is the treatment of choice for pyoderma gangrenosum refractory to steroids and 6‐mercaptopurine should be used as maintenance therapy.