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Effective use of switching biologics for ulcerative colitis complicated with pyoderma gangrenosum and primary sclerosing cholangitis
  1. Kenta Iwahashi,
  2. Yuichiro Kuroki,
  3. Yuichi Takano and
  4. Masatsugu Nagahama
  1. Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
  1. Correspondence to Dr Kenta Iwahashi; nibornirococ1735{at}gmail.com

Abstract

Although prednisolone, granulocyte/monocyte apheresis, calcineurin inhibitor and anti-tumour necrosis factor (TNF) therapy are generally used, no treatment strategy for inflammatory bowel disease complicated with pyoderma gangrenosum (PG) has been established yet. Herein, we present the case of a 29-year-old man with ulcerative colitis (UC) complicated with primary sclerosing cholangitis. When UC relapsed and PG developed, prednisolone and granulocyte/monocyte apheresis were used; however, their therapeutic effects were deemed insufficient. After 2 weeks, adalimumab (ADA) induced remission; however, his UC and PG relapsed 20 weeks later. As a result of switching to infliximab, since a loss of response to ADA was deemed to have occurred, remission was reintroduced and subsequently maintained for 40 weeks. We conclude that anti-TNF-α antibodies might be selected as the first choice when PG and UC are refractory to treatment, and a switch to anti-TNFs should be considered when the effect is still insufficient.

  • ulcerative colitis
  • dermatology

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Footnotes

  • Contributors YK and MN supervised the manuscript and treatment. KI, YK and YT are physicians in charge of this patient. KI and YK wrote the paper with input from all authors.

  • 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.

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