Pyoderma gangrenosum in a patient with acantholytic pemphigus

Background. Currently, the nosological entity of pyoderma gangrenosum (PG) is not defined. This disease is supposed to be neutrophilic vasculopathy, severe autoimmune dermatosis associated with systemic or chronic inflammatory diseases, or severe angiitis due to sensitization to various microorganisms. Due to the indefinite nosological entity, therapy of PG presents significant difficulties. The use of systemic glucocorticosteroids (sGCSs), cytostatics, bioengineered drugs, vasoactive drugs, laser and magnetotherapy, and efferent methods is often ineffective. In the literature there are a sufficient number of publications on the development of PG against the background of various, including severe systemic autoimmune diseases. However, in the literature available to us, we did not find descriptions of cases of its development against the background of such a serious autoimmune disease as acantholytic pemphigus (AP). Description of the clinical case. The article provides a clinical case of the development of PG in a 42-year-old patient suffering from vulgar AP. According to the authors, the isolated use of high doses of cGCS, the addition of cytostatic drugs and efferent methods to therapy were ineffective. At the same time, the appearance of ulceration in the area of AP foci does not indicate the ineffectiveness of pemphigus therapy and, most importantly, does not serve as an indication for increasing the daily dose of systemic corticosteroids, but indicates the development of PG against the background of severe immunosuppression caused by massive corticosteroid therapy. Conclusion. The effectiveness of the combined treatment, including cGCS, cytostatics, the use of two antibacterial drugs that potentiate the effect of each other, and local use of chymotrypsin, has been shown.

pyoderma gangrenosum, acantholytic pemphigus, systemic glucocorticosteroids, chymotrypsin, cytostatics, combined treatment