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GEORGE J.HRUZAMDLYNN A.CORNELIUSMDJOHNSTARRMD
A 32-year-old white woman with systemic lupus erythematosus presented with a 2-year history of refractory pyoderma gangrenosum on the left pretibial area. The lesion eroded to expose underlying tendons and muscles, and involvement of deep structures caused mononeuritis, with resultant unilateral foot drop and intractable pain. Therapeutic regimens that had been used during this 2-year period but had failed to arrest progression included the following: prednisone, 1 mg/kg per day; prednisone in combination with azathioprine, 2.5 mg/kg per day; dapsone, 100 mg/d; oral cyclophosphamide, 2 mg/kg per day; and intralesional triamcinolone acetonide injections. Three intravenous pulses of methylprednisolone, 1 g each, as well as 2 intravenous cyclophosphamide pulses, 500 mg per pulse, were given to the patient without additional improvement. Immediately prior to the initiation of the new therapeutic regimen, the patient had been treated with prednisone, 1 mg/kg per day, in conjunction with microemulsion cyclosporine, 5 mg/kg per day, for 4 months. All these therapeutic regimens had demonstrated an inability to induce healing of the lesion.
Nousari HC, Lynch W, Anhalt GJ, Petri M. The Effectiveness of Mycophenolate Mofetil in Refractory Pyoderma Gangrenosum. Arch Dermatol. 1998;134(12):1509–1511. doi:https://doi.org/10.1001/archderm.134.12.1509
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