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.