Crohn's Disease Associated Pyoderma Gangrenosum Treated with Adalimumab

Yıl 2012, , 93 - 95, 01.01.2012

Despoina Kakagia Eleni Efremidou Nikolaos Lyratzopoulos Alexandros Mitrakas Michael Pitiakoudis George Kouklakis

https://doi.org/10.5174/tutfd.2010.04446.1

Öz

Pyoderma gangrenosum is a known, though infrequent, ulcerative skin lesion that is often associated with systemic inflammatory and immunologic diseases. Objective: To present the efficacy of Adalimumab, a fully human Tumour Necrosis Factor-α antagonist, in the treatment of pyoderma gangrenosum associated with Crohn's disease. Methods: A young male patient with pyoderma gangrenosum of the shin as the first sign of clinically active Crohn's disease, who was treated with Adalimumab, is herein presented. Results: Almost complete healing of the lesion was achieved after 12 weeks of treatment. Conclusions: Successful treatment outcome suggests that Adalimumab is not only a therapeutic option for Crohn's disease but may also be a safe and effective therapy for Pyoderma gangrenosum associated with the disease. Pyoderma gangrenosum should be suspected in any cutaneous ulcerative lesion occurring in patients with Crohn's disease. Turkish Başlık: Adalimumab ile Tedavi Edilen, Crohn Hastalığı ile İlişkili Piyoderma Gangrenosum Anahtar Kelimeler: Adalimumab, Crohn hastalığı, immunomodülatör ajanlar, pyoderma gangrenosum Pyoderma gangrenosum seyrek olmasına rağmen, sıklıkla sistemik inflamatuar ve immünolojik hastalıklar ile ilişkili, ülseratif cilt lezyonudur. Amaç: Crohn hastalığı ile ilişkili pyoderma gangrenosumun tedavisinde tam bir insan Tümör Nekrozis Faktör-α antagonisti olan Adalimumabın etkinliğini göstermektir. Yöntem: Burada klinik olarak aktif Crohn hastalığının ilk bulgusu olarak bacağında piyoderma gangrenosum olan genç erkek hasta sunulmaktadır. Bulgular: 12 haftalık tedaviden sonra lezyonda neredeyse tam bir iyileşme sağlandı. Sonuçlar: Başarılı tedavi sonuçları Adalimumabın Crohn hastalığında sadece terapötik bir seçenek olmadığı, ayrıca hastalıkla ilişkili Piyoderma gangrenosum için de güvenli ve etkili bir tedavi olduğunu göstermektedir. Crohn hastalığı olan hastalarda ortaya çıkan herhangi bir kutanöz ülseratif lezyonda Piyoderma gangrenosumdan şüphelenilmelidir.

Anahtar Kelimeler

Adalimumab, Crohn's disease, immunomodulating agents, pyoderma gangrenosum

Crohn's Disease Associated Pyoderma Gangrenosum Treated with Adalimumab

Öz

Kaynakça

• Jacob SE, Weisman RS, Kerdel FA. Pyoderma gangrenosum-reb- el without a cure? Int J Dermatol 2008;47:192-4. [CrossRef]
• Barrie A, Regueiro M. Biologic therapy in the management of extraintestinal manifestations of inflammatory bowel disease. In- flamm Bowel Dis 2007;13:1424-9. [CrossRef]
• Ljung T, Staun M, Grove O, Fausa O, Vatn MH, Hellstrom PM. Pyoderma gangrenosum associated with crohn disease: effect of TNF-alpha blockade with infliximab. Scand J Gastroenterol 2002;37:1108-10. [CrossRef]
• Colombel JF, Sandborn WJ, Rutgeerts P. Adalimumab for mainte- nance of clinical response and remission in patients with Crohn’s disease: the CHARM trial. Gastroenterology 2007;132:52-65. [CrossRef]
• Hinojosa J, Gomollon F, García S. Efficacy and safety of short term adalimumab treatment in patients with active Crohn’s dis- ease who lost response or showed intolerance to infliximab: a prospective, open-label, multicentre trial. Aliment Pharmacol Ther 2007;25:409-18. [CrossRef]
• Juillerat P, Mottet C, Froehlich F, Felley C, Vader JP, Burnand B, et al. Extraintestinal manifestations of Crohn’s disease. Digestion 2005;71:31-6. [CrossRef]
• Kouklakis G, Moschos J, Leontiadis GI, Kadis S, Mpoumponaris A, Molyvas E, et al. Infliximab for treatment of Pyoderma Gan- genosum associated with clinically inactive Crohn’s disease. A case report. Rom J Gastrenterol 2005;14:401-3.
• Sands BE. Immunosuppressive drugs in ulcerative colitis: twisting facts to suit theories? Gut 2006;55:437-41. [CrossRef]
• Alexis AF, Strober BE. Off-label dermatologic uses of anti-TNF-a therapies. J Cutan Med Surg 2005;9:296-302. [CrossRef]
• Sandborn WJ, Hanauer SB, Rutgeerts P. Adalimumab for main- tenance treatment of Crohn’s disease: results of the CLASSIC II Trial. Gut 2007;56:1232-9. [CrossRef]
• Stichenwirth M, Riedl E, Pehamberger H, Tappeiner G. Pyoderma gangrenosum in a patient with seronegative rheumatoid arthritis during therapy with adalimumab: toxic effects of adalimumab or failure of adalimumab to prevent the onset of this phenomenon? Arch Dermatol. 2008;144:817-8. [CrossRef] 95 2012; 29: 93-5 Kakagia et al.
• Pyoderma Gangrenosum Treated with Adalimumab