ABSTRACT

gangrenosum is a rare, non-infectious neutrophilic dermatose of unknown etiology characterized by tissue destruction and neutrophilic infiltration of the dermis. The pathogenesis is not fully understood but it is thought that impaired neutrophil chemotaxis or reactivation, abnormal immun reactivity or the role of TNF-alpha which is a strong proinflammatory cytokine secreted by polymorphonuclear cells in early stage of acute inflammation. The main systemic treatment is immunsupressive treatment in pyoderma gangrenosum. For this reason, some immunmodulatory agents such as oral corticosteroids, cyclosporine, azathioprine, methotrexate, cyclophosphamide, thalidomide, mycophenolate mofetil and chlorambucil have been used. Our patient was treated with methylprednisolone (80 mg daily, the dosage was decreased to 12 mg about 7-months period gradually), dapsone (100 mg daily for a month), cyclosporine (for a month) and azathioprine (150 mg daily for five months). Then our patient received an infusion of infliximab 5mg/kg (400 mg in total) at weeks 0, 2, and 6. The ulcerated lesion, which was 3x4 cm in size, was completely healed after the second dose. The present case supports that infliximab may be an effective and safe alternative treatment in pyoderma gangrenosum refractory to convensional therapies.