Dramatic Response of Rapid Progressive Atypical Pyoderma Gangrenosum to Infliximab in a Patient with Ulcerative Colitis

Pyoderma gangrenosum (PG) is a relatively uncommon disorder associated with autoimmune and inflammatory conditions, including inflammatory bowel disease (IBD). PG’s prevalence ranges from 0.4 - 2.6% in patients with IBD. We describe a 34-year-old man with ulcerative colitis (UC) who was referred to our center with some small follicular and pustular lesions rapidly progressing into a painful necrotic ulcer in the right axilla. The ulcer was not responsive to broad spectrum antibiotics and topical cytotoxic agents like tacrolimus. Finally, a dramatic response was observed after initiating anti-tumor necrosis factor (anti-TNF) treatment with infliximab (10 mg/kg) within a week. A significant reduction in size and necrotic tissue was achieved one month after the index date of the prescription of infliximab. A 2-month follow-up of the patient revealed complete healing of the lesion.