Improvement of idiopathic pyoderma gangrenosum during treatment with anti-tumor necrosis factor alfa monoclonal antibody

Pyoderma gangrenosum (PG) is an inflammatory ulcerative condition of unknown etiology. An autoimmune mechanism including immune complex–mediated neutrophilic vascular reactions has been suggested. The role of tumor necrosis factor (TNF) in PG remains unclear. Evidence supports the idea that TNF plays a role in chronic inflammation and migration of neutrophils to these lesions. PG is frequently associated with various diseases, but up to 50% of cases are idiopathic. There are several reports describing the successful use of infliximab™(Remicade®, Centocor, Inc, Horsham, Pa), a chimeric antitumor necrosis factor α monoclonal antibody, in the treatment of inflammatory bowel disease– associated PG, but there have been few reported cases of infliximab in the treatment of idiopathic PG. The authors present a dramatic improvement in 4 cases of idiopathic PG of the lower leg treated with infliximab.