Infliximab as a treatment for recalcitrant pyoderma gangrenosum
Infliximab as a treatment for recalcitrant pyoderma gangrenosum
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英夫利昔单抗治疗顽固性坏疽性脓皮病
DOI：
10.1111/j.1365-2230.2004.01470.x
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发表时间：
2004
影响因子：
4.1
通讯作者：
J. Lear
中科院分区：
文献类型：
--
作者：
M. Singh;S. Andrew;J. Lear
英夫利西单抗被确定为治疗类风湿性关节炎1和瘘管性克罗恩病2，最近，银屑病。3我们报告了一个患克罗恩病的顽固性坏疽性脓疡患者，在单次输注英夫利昔单抗后，他的坏疽性脓疡显著改善。一名58岁男子提出了开放性伤口在腹股沟区和出生裂缝。它们开始是腹股沟的暗红色、溃疡性斑块，但逐渐恶化，伴有溃疡和流泪。就诊时没有肠道症状。他全身状况良好，有类风湿性关节炎和红斑痤疮病史。入院时，患者接受双氯芬酸75 mg每日一次、泼尼松龙7.5 mg和米诺环素100 mg每日一次治疗。针对细菌和真菌感染的初始治疗（静脉注射青霉素和克霉唑乳膏）在1周后无反应。当临床诊断为坏疽性脓疡时，他被转诊到皮肤科。患者开始接受40 mg泼尼松龙和0.5%丙酸氯倍他松和新霉素（Dermovate NN）治疗。由于不完全消退，尝试了各种治疗，包括他克莫司0.1%和环孢素（高达2.5 mg/kg）。不幸的是，6个月后，他因全身不适伴严重腹股沟溃疡入院。停用环孢素，重新使用泼尼松龙。他克莫司（0.3%）在dermovate中的加入使他的坏疽性化脓部分消退（图1a）。另一个6个月后，他因出血性腹泻、体重减轻、腹股沟、会阴和口腔溃疡再次入院。乙状结肠镜检查显示粘膜炎症和溃疡，符合炎症性肠病。结肠组织学证实粘膜溃疡，隐窝中的活动性慢性炎症，隐窝肿胀延伸到固有肌层。这些表现，结合临床表现，提示克罗恩病。同时对溃疡的会阴部进行皮肤活检，显示明显的混合性炎症和表面溃疡，无肉芽肿或微生物。失败的医疗管理导致功能障碍性袢回肠造口术和单次输注英夫利西单抗（5 mg/kg）。他的肠道症状消失了，
Infliximab is established as a treatment for rheumatoid arthritis1 and fistulating Crohn’s disease2 and more recently, psoriasis. 3 We report a patient with recalcitrant pyoderma gangrenosum who developed Crohn’s disease and following a single infusion of infliximab his pyoderma gangrenosum dramatically improved. A 58-year-old man presented with open wounds in both inguinal regions and natal cleft. They started as dark red, pruritic patches in the groin, but gradually deteriorated with ulceration and weeping. There were no bowel symptoms at presentation. He was systemically well with a history of rheumatoid arthritis and acne rosacea. On admission, he was on diclofenac 75 mg once a day, prednisolone 7.5 mg and minocycline 100 mg once a day. Initial treatments (intravenous penicillin and clotrimazole cream) aimed at bacterial and fungal infection produced no response after 1 week. He was referred for a dermatological opinion when the clinical diagnosis of pyoderma gangrenosum was made. The patient was commenced on 40 mg prednisolone and clobetasone proprionate 0.5% and neomycin (Dermovate NN). Due to incomplete resolution, various treatments were tried, including tacrolimus 0.1%, and ciclosporin (up to 2.5 mg⁄ kg). Unfortunately, 6 months later he was admitted to hospital systemically unwell with gross inguinal ulceration. Ciclosporin was stopped and prednisolone reintroduced. Tacrolimus (0.3%) in dermovate was added with partial resolution of his pyoderma gangrenosum (Fig 1a).Another 6 months later he was readmitted with bloody diarrhoea, weight loss, ulcers in his groin, perineum and mouth. Sigmoidoscopy showed mucosal inflammation and ulceration consistent with inflammatory bowel disease. Histology of the colon confirmed ulceration of the mucosa, active chronic inflammation in the crypts with crypt abscesses extending into the muscularis propria. These appearances, combined with the clinical picture, suggested Crohn’s disease. A skin biopsy of the ulcerated perineum, taken at the same time, showed marked mixed inflammation and surface ulceration with no granulomata or organisms. Failed medical management led to a defunctioning loop ileostomy and a single infusion of infliximab (5 mg⁄ kg). His bowel symptoms resolved and the