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Case report
Hyperbaric oxygen therapy for refractory pyoderma gangrenosum: a salvage treatment
  1. Rui de Sousa Magalhães1,2,3,
  2. Maria João Moreira1,2,3,
  3. Bruno Rosa1,2,3 and
  4. José Cotter1,2,3
  1. 1Gastroenterology Department, Hospital Senhora da Oliveira, Guimarães, Portugal
  2. 2Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
  3. 3ICVS/3B’s, PT Government Associate Laboratory, Guimarães/Braga, Portugal
  1. Correspondence to Dr Rui de Sousa Magalhães; rui.magalhaes.med{at}gmail.com

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.

  • inflammatory bowel disease
  • skin

https://doi.org/10.1136/bcr-2020-238638

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    Footnotes

    • Contributors RdSM, Corresponding author: Was involved in all stages of the manuscript construction, from the clinical decision-making to the conduct, reporting, conception and design, literature review and writing the final paper. MJM: Was involved in the clinical decision-making and correction of the final manuscript. BR: Was involved in the clinical decision-making and correction of the final manuscript. JC: Was involved in the clinical decision-making and correction of the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.