1,596
Views
8
CrossRef citations to date
0
Altmetric
Case Report

Successful treatment with tacrolimus of refractory pyoderma gangrenosum with pouchitis after restorative proctocolectomy for ulcerative colitis

, , , , , , , , , , , , , & show all
Pages 142-146 | Received 02 Apr 2018, Accepted 11 Jul 2018, Published online: 03 Dec 2018

Figures & data

Figure 1. Gross appearance of the skin ulcers: the dorsum of the right hand (A), left wrist (B) and left lower leg (C) on admission. The dorsum of the right hand (D), left wrist (E) and left lower leg (F) demonstrating complete regression after treatment with 10 mg oral PSL and oral tacrolimus on day 78 after admission.

Figure 1. Gross appearance of the skin ulcers: the dorsum of the right hand (A), left wrist (B) and left lower leg (C) on admission. The dorsum of the right hand (D), left wrist (E) and left lower leg (F) demonstrating complete regression after treatment with 10 mg oral PSL and oral tacrolimus on day 78 after admission.

Figure 2. Histopathological findings of skin and ileal pouch. (A) Skin biopsies showed superficial and deep perivascular dermatitis without epidermal changes. (B) There were hemorrhage and chronic inflammation with giant cells and fibrosis in the epidermis, but there were no findings of vasculitis, such as vessel wall neutrophilic infiltration. (C) Histological findings of pouch mucosa showed total villous atrophy. (D) Moderate inflammatory cell infiltration and cryptitis.

Figure 2. Histopathological findings of skin and ileal pouch. (A) Skin biopsies showed superficial and deep perivascular dermatitis without epidermal changes. (B) There were hemorrhage and chronic inflammation with giant cells and fibrosis in the epidermis, but there were no findings of vasculitis, such as vessel wall neutrophilic infiltration. (C) Histological findings of pouch mucosa showed total villous atrophy. (D) Moderate inflammatory cell infiltration and cryptitis.

Figure 3. Endoscopic findings showed active ulcerations of the pouch and anastomotic site on the 34th day after admission (A, B). After treatment with oral tacrolimus, the endoscopic findings dramatically improved on day 78 after admission (C, D).

Figure 3. Endoscopic findings showed active ulcerations of the pouch and anastomotic site on the 34th day after admission (A, B). After treatment with oral tacrolimus, the endoscopic findings dramatically improved on day 78 after admission (C, D).

Table 1. Primary laboratory data on initial visit.