Infliximab-induced Remission of Postoperative Pyoderma Gangrenosum: A Case Report and Literature Review

Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine

Background: Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by painful, rapidly progressive cutaneous ulcers. Postoperative PG (PPG) represents a distinct variant that develops at surgical or traumatic sites due to the pathergy phenomenon. Early diagnosis is often challenging, as it requires the exclusion of other causes such as infection, and misdiagnosis may lead to inappropriate surgical interventions and treatment delays. Methods: We report the case of a 69-year-old man who developed extensive ulcerative lesions at both surgical sites following bilateral high ligation of the great saphenous veins for chronic venous insufficiency. Despite multiple surgical debridements and broad-spectrum antibiotics, the lesions continued to worsen. A diagnosis of PPG was made, and systemic corticosteroid therapy was initiated, resulting in partial improvement. Results: Infliximab was prescribed, leading to complete healing, and all immunosuppressive agents were discontinued, with the patient remaining in remission. This case highlights the importance of recognizing PPG in postsurgical ulcers that fail to respond to conventional therapy and demonstrated the efficacy of infliximab. A review of the literature on clinical outcomes and treatment regimens involving infliximab is also provided. Conclusions: Our case supports tumor necrosis factor-α inhibitors as effective steroid-sparing treatment for severe or refractory PPG.