mercaptopurine and Pyoderma-Gangrenosum

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis often associated with inflammatory bowel disease (IBD). The literature has suggested that PG-IBD is usually associated with ulcerative colitis.. We reviewed the PG-IBD cases at the Mater Health Services' Adult Hospital in Brisbane between 1998 and 2009 through assessment of a comprehensive web database of IBD patients and verification of chart information of PG-IBD cases.. PG-IBD at Mater was associated with clinically mild colonic IBD, with erythema nodosum, and with female sex. All PG-IBD responded eventually to increased immunomodulatory therapy.. We discuss why PG-IBD is associated with clinically mild colonic IBD be it ulcerative colitis, Crohn's or indeterminate colitis.

Topics: Adult; Anti-Inflammatory Agents; Colitis, Ulcerative; Crohn Disease; Cyclosporins; Female; Humans; Hydrocortisone; Immunosuppressive Agents; Male; Mercaptopurine; Middle Aged; Prevalence; Pseudomonas aeruginosa; Pseudomonas Infections; Pyoderma Gangrenosum; Sex Factors; Wounds and Injuries

Pyoderma gangrenosum is a rare ulcerative skin disorder mainly occurring in adults. It is seen less frequently in children. The cause is unknown but it may occur in association with several disorders. Osteomyelitis is a very rare association. We report a case of pyoderma gangrenosum associated with osteomyelitis in a two-year-old girl.

Topics: Child, Preschool; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Mercaptopurine; Osteomyelitis; Prednisone; Pyoderma Gangrenosum; Sulfasalazine

Pyoderma gangrenosum complicates inflammatory bowel disease in 2-3% of patients and often fails to respond to antibiotics, steroids, surgical debridement or even colectomy.. 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 21. 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.. 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.. Intravenous cyclosporine is the treatment of choice for pyoderma gangrenosum refractory to steroids and 6-mercaptopurine should be used as maintenance therapy.

Topics: Adrenal Cortex Hormones; Adult; Aged; Cyclosporine; Drug Resistance; Female; Humans; Immunosuppressive Agents; Inflammatory Bowel Diseases; Infusions, Intravenous; Male; Mercaptopurine; Middle Aged; Pyoderma Gangrenosum; Retrospective Studies; Treatment Outcome