The use of high-dose immunoglobulin in the treatment of pyoderma gangrenosum

BACKGROUND: Immunosuppressive medications such as corticosteroids and cyclo sporin are the most commonly employed therapies in pyoderma gangrenosum. We describe a patient with multiple ulcers of pyoderma gangrenosum on the low er extremities in whom immunosuppressive therapy caused serious side effect s and had to be discontinued but who was subsequently treated successfully with high dose intravenous immunoglobulin (IVIG), METHODS: IVIG was given intravenously at a dose of 400 mg/kg per day for 5 consecutive days. After 1 week there was an arrest in the progression of th e ulcers and a marked reduction in pain. Two weeks later clinical improveme nt of the ulcers was observed, Subsequently, IVIG was given at a dose of 1 g/kg per day for 2 consecutive days. RESULTS: The treatment induced a dramatic clinical improvement of one ulcer and healing of the others. Side effects were minimal and well tolerated, a nd consisted of chills and a slight fever, which resolved with the administ ration of acetaminophen. CONCLUSION: We feel that IVIG call be used in patients with pyoderma gangre nosum in whom conventional therapies are ineffective or produce serious sid e effects.