Hyperbaric oxygen therapy for refractory pyoderma gangrenosum: a salvage treatment.

Abstract

A 42-year-old woman with left-side ulcerative colitis (E2 - rectum to splenic flexure) was diagnosed with pyoderma gangrenosum (PG) on a persistent ulcerated wound with peripheral erythema, in the left leg's gemelar surface, associated with tenderness and pain. Due to incomplete response to wound care and oral prednisolone, treatment with infliximab was initiated. As PG remained unresponsive after 12 weeks, the patient was switched to adalimumab with concomitant oral prednisolone. Before the second induction dosage of adalimumab, the refractory PG complicated with a superinfection by Pseudomonas aeruginosa A course of wide spectrum antibiotic therapy, daily wound care including negative pressure bandages and a physiotherapy rehabilitation programme controlled the infection, but the pyoderma persisted non-healed, with visible deep muscle layers and tendons. We proposed hyperbaric oxygen therapy in addition to weekly adalimumab, achieving full remission of the PG and recovering of the left foot's function.

• Authors: Rui de Sousa Magalhães, Maria João Moreira, Bruno Rosa, José Cotter
• Journal: BMJ case reports (BMJ Case Rep) Vol. 14 Issue 2 (Feb 18 2021) ISSN: 1757-790X [Electronic] England
• PMID: 33602761 (Publication Type: Case Reports, Journal Article)
• Copyright: © BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Infliximab

Topics

• Adult
• Colitis, Ulcerative
• Female
• Humans
• Hyperbaric Oxygenation
• Infliximab
• Pyoderma Gangrenosum (therapy)
• Salvage Therapy