Hyperbaric oxygen therapy for refractory pyoderma gangrenosum: a salvage treatment

A 42-year-old woman with left-side ulcerative colitis (E2 – rectum to splenic flexure) was diagnosed with pyoderma gangrenosum (PG) on a persistent ulcerated wound with peripheral erythema, in the left leg’s gemelar surface, associated with tenderness and pain. Due to incomplete response to wound ca...

Full description

Saved in:
Bibliographic Details
Published in:BMJ case reports 2021-02, Vol.14 (2), p.e238638
Main Authors: de Sousa Magalhães, Rui, Moreira, Maria João, Rosa, Bruno, Cotter, José
Format: Article
Language:English
Subjects:
Adult
Antibiotics
Biopsy
Case Report
Case reports
Colitis, Ulcerative
Female
Fever
Humans
Hyperbaric Oxygenation
Infections
Inflammatory bowel disease
Infliximab
Laboratories
Monoclonal antibodies
Oxygen therapy
Pain
Proteins
Pyoderma Gangrenosum - therapy
Salvage Therapy
Skin diseases
Tumor necrosis factor-TNF
Ulcers
Wound healing
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:A 42-year-old woman with left-side ulcerative colitis (E2 – rectum to splenic flexure) was diagnosed with pyoderma gangrenosum (PG) on a persistent ulcerated wound with peripheral erythema, in the left leg’s gemelar surface, associated with tenderness and pain. Due to incomplete response to wound care and oral prednisolone, treatment with infliximab was initiated. As PG remained unresponsive after 12 weeks, the patient was switched to adalimumab with concomitant oral prednisolone. Before the second induction dosage of adalimumab, the refractory PG complicated with a superinfection by Pseudomonas aeruginosa. A course of wide spectrum antibiotic therapy, daily wound care including negative pressure bandages and a physiotherapy rehabilitation programme controlled the infection, but the pyoderma persisted non-healed, with visible deep muscle layers and tendons. We proposed hyperbaric oxygen therapy in addition to weekly adalimumab, achieving full remission of the PG and recovering of the left foot’s function.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2020-238638