Pyoderma Gangrenosum and Palisaded Neutrophilic Granulomatous Dermatitis in a Patient with Rheumatoid Arthritis Treated with Apremilast

Armin Zgraggen, Lara Valeska Maul, Paul Hasler and Ruediger B Mueller

Department of Rheumatology, Kantonsspital Aarau, Switzerland Department of Dermatology, University hospital Basel, Switzerland

^*Correspondance to: Armin Zgraggen 

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Abstract:

Background: Pyoderma Gangrenosum (PG) and Interstitial Granulomatous Dermatitis (IGD) are rare manifestations in association with chronic inflammatory rheumatic diseases. Conventional therapeutic strategies involve Glucocorticosteroids (GC), DMARDs (Disease Modifying Drugs) and TNF antagonists. Method: We report a case of a rheumatoid arthritis patient suffering from a reactive granulomatous dermatitis manifesting with features of a PG and IGD refractory to treatment with high dose GC and infliximab. Result: Upon addition of apremilast to infliximab and glucocorticoids the skin cleared and the glucocorticoids dose could be tapered. Conclusion: Apremilast may be a therapeutic agent in PG and IGD refractory to conventional therapeutic strategies.

Keywords:

Pyoderma gangrenosum; interstitial granulomatous dermatitis; glucocorticosteroids;
in liximab

Cite the Article:

Zgraggen A, Valeska Maul L, Hasler P, Mueller RB. Pyoderma Gangrenosum and Palisaded Neutrophilic Granulomatous Dermatitis in a Patient with Rheumatoid Arthritis Treated with Apremilast. Ann Clin Case Rep. 2020; 5: 1807.