Pyoderma gangrenosum associated with chronic refractory pouchitis: a case successfully treated with infliximab

Dimitra Koumaki; Eleni Orfanoudaki; Angeliki Machaira; Eleni Lagoudaki; Konstantinos Krasagakis; Ioannis E. Koutroubakis

Authors Dimitra Koumaki, Eleni Orfanoudaki, Angeliki Machaira, Eleni Lagoudaki, Konstantinos Krasagakis, Ioannis E. Koutroubakis.

Abstract

Pouchitis-associated pyoderma gangrenosum (PG) is rare, with only a few cases reported in the literature. Here we report a rare case of chronic refractory pouchitis-associated PG successfully treated with infliximab (IFX). A 43-year-old Caucasian male, with a past medical history of chronic refractory pouchitis after proctocolectomy and ileal pouch-anal anastomosis for severe ulcerative colitis, developed PG on his right lower leg. This subsided after treatment with intravenous IFX at a dose of 5 mg/kg at weeks 0, 2, 6 and then every 8 weeks. Pouchitis-associated PG is rare. Clinicians should be aware of the risk of PG in patients who suffer from pouchitis and develop rapidly extensive painful ulcers. Furthermore, the therapeutic choice should take into consideration the effectiveness of IFX on the inflammatory background, which sustains both intestinal and skin disease in these types of patients.

Keywords Pouchitis, ulcerative colitis, inflammatory bowel disease, pyoderma gangrenosum, infliximab

Ann Gastroenterol 2020; 33 (4): 433-435