摘要
Pyoderma gangrenosum (PG )is an ulcerating noninfectious disease of the skin seen in 1 to 5% of patients with in- flam matory boweldisease.The pathogenesis ofPG has yet to be determ ined but m ay be related to abnorm al Tcell responses and the production ofTNF-α,a powerfulproin- flam m atory cytokine.Inflixim ab,a chim eric m onoclonal antibody to TNF-α,has been approved forthe treatm entof Crohn s disease.W e presentfour patients with PG treated with Inflixim ab for fistulizing Crohn s in whom com plete healing ofPG was achieved.Four patients with active fis- tulizing Crohns disease and PG were treated.Allpatients were fem ales ranging in age from 48to 60years,with a m ean age of54years.Three offourpatientshad PG lesions located on the lowerextrem ities;one patienthad peristom al disease.All patients had at least colonic involvem ent of theirCrohn s.The patientsreceived eithera single infusion or a series ofthree 5m g /kg Inflixim ab infusions.Allfour patients dem onstrated rapid healing ofPG within 4weeksof the first infusion of Inflixim ab.PG healing followed im - provem ent in bowel disease.Com plete resolution without recurrence was noted in all patients.Rapid resolution of PG wasnoted in fourfem ale patientswith fistulizing Crohn s disease treated with Inflixim ab.H ealing was com plete, without recurrence.The anti-TNF-αproperties of Inflix- im ab suggest that healing m ay be m ediated by the drugs effect on cytokine pathways,perhaps by blunted T cell activation early in the inflam m atory cascade.W e suggest an independenteffectofInflixim ab on PG.
Pyoderma gangrenosum (PG )is an ulcerating noninfectious disease of the skin seen in 1 to 5% of patients with in- flam matory boweldisease.The pathogenesis ofPG has yet to be determ ined but m ay be related to abnorm al Tcell responses and the production ofTNF-α,a powerfulproin- flam m atory cytokine.Inflixim ab,a chim eric m onoclonal antibody to TNF-α,has been approved forthe treatm entof Crohn s disease.W e presentfour patients with PG treated with Inflixim ab for fistulizing Crohn s in whom com plete healing ofPG was achieved.Four patients with active fis- tulizing Crohns disease and PG were treated.Allpatients were fem ales ranging in age from 48to 60years,with a m ean age of54years.Three offourpatientshad PG lesions located on the lowerextrem ities;one patienthad peristom al disease.All patients had at least colonic involvem ent of theirCrohn s.The patientsreceived eithera single infusion or a series ofthree 5m g /kg Inflixim ab infusions.Allfour patients dem onstrated rapid healing ofPG within 4weeksof the first infusion of Inflixim ab.PG healing followed im - provem ent in bowel disease.Com plete resolution without recurrence was noted in all patients.Rapid resolution of PG wasnoted in fourfem ale patientswith fistulizing Crohn s disease treated with Inflixim ab.H ealing was com plete, without recurrence.The anti-TNF-αproperties of Inflix- im ab suggest that healing m ay be m ediated by the drugs effect on cytokine pathways,perhaps by blunted T cell activation early in the inflam m atory cascade.W e suggest an independenteffectofInflixim ab on PG.
