Hidradenitis Suppurativa and Concomitant Pyoderma Gangrenosum Treated With Infliximab
Pyoderma gangrenosum (PG) and hidradenitis suppurativa (HS) are rare chronic inflammatory dermatoses of unknown etiologies that often are refractory to conventional treatments. The therapeutic benefits of tumor necrosis factor a (TNF-α) inhibitors have been reported in patients with refractory PG or HS. The copresentation of these 2 diseases has previously been described in several cases in the literature and may present a therapeutic challenge. We present the case of a 51-year-old man who developed widespread inflammatory ulcers affecting approximately 50% of the body surface area and subsequent chronic debilitation from severe pain. He was ultimately diagnosed with concurrent PG and HS. Both diseases remitted in response to treatment with infliximab, which resulted in complete restoration of skin integrity and resolution of his chronic severe pain.
Practice Points
- Pyoderma gangrenosum (PG) and hidradenitis suppurativa (HS) are rare chronic inflammatory dermatoses that may coexist in the same patient.
- Infliximab may represent an effective therapeutic option for the treatment of concurrent PG and HS that is refractory to conventional therapies.
Conclusion
In our patient with concurrent PG and HS, both conditions showed dramatic improvement with in-fliximab therapy, and this response has been sustained on 5-mg/kg infliximab maintenance therapy every 8 weeks for the last 3 years. Our case suggests that infliximab may represent an effective therapeutic option for the treatment of concurrent PG and HS that is refractory to conventional therapies. It is yet to be seen whether our patient will continue to experience sustained remission in both his PG and HS permitting the discontinuation of infliximab. Continued study of infliximab and other TNF-α inhibitors is necessary to establish their long-term safety and efficacy for use in patients affected by both HS and PG.
