peristomal pyoderma gangrenosum - 10th ecet congress oporto 2009
TRANSCRIPT
PERISTOMAL PYODERMA GANGRENOSUM: AN INTERDISCIPLINARY APPROACH
ET. G. Militello – Ostomy Centre ASL 4 Prato – [email protected] – [email protected]. M. Antonini – Ostomy Centre ASL 11 Empoli – [email protected] – [email protected] Maria Giovanna Brunasso Vernetti, MD, Galliera Hospital, Departement of Dermatology, Genoa-Italy
INTRODUCTION
We present a 40 year-old white female afected of ulcerative colitis who developed skin lesions compatible with pyoderma gangrenosum located on the prestomal skin and on the lower legs. After a partial colectomy
the patient was scheduled to received Infliximab therapy at 5 mg/kg/day at day-0, week-2, 6 and every 8 weeks. Surprisingly the patient started to
developed skin lesions after the second infliximab infusion. Because of the worsening of the skin lesions after the thrird infliximab infusion, the
patient requested the suspension of the drug. At the time, cyclosporine A at 5 mg/kg/day was started with notorious improvement of the
cutaneous lesions but also of the rectal bleeding and the weight loss.
AIMS & METHODS
Infliximab was administered at the moment of the ulcerative lesions’ appearance. Due to the pain’s increase Infliximab’s infusion was stopped
and the Cyclosporin’s administration 5mg/Kg/die was started. After approximately 3 weeks of treatment, the rectal bleeding and the pain were under control. The peristomal ulcerations (classified according to SACS L4, TV) and the ulcerations at the inferior limbs were treated with advance medications. According to the treatment scheme, Prontosan
solution, AquacelAg, Tegaderm film, idrocolloidal plate and polyurethane foam were used.
RESULTS
Ulcerated lesions of the lower legs rapidly improved after 20 days, the peristomal lesions required a longer healing time because of the koebner pathergy phenomenon elicited by
the peristomal medication. Th edfinitive healing of the peristomal lesions was obtained after 9 months of therapy.
(February to November 2008)
CONCLUSIONS
The interdisciplinary team work between the nursing specialized team and the dermatologist allowed the prompt
pyderma gangrenosum diagnosis and the quick therapeutical intervention in order to treat a very disabling
condition that higly impairs patients quality of life.