Refractory Takayasu arteritis with recurrent pyoderma gangrenosum: a therapeutic challenge with case-based review

Abstract Takayasu arteritis (TA) is an uncommon chronic granulomatous large-vessel vasculitis affecting the aorta and its branches. Pyoderma gangrenosum (PG) is a chronic neutrophilic dermatosis characterized by rapidly developing painful ulcers. The association of PG with TA is relatively uncommon. We report a case of a 22-year-old lady with a history of recurrent pyoderma lesions for 4 months following which she developed right upper limb claudication. She underwent contrast-enhanced magnetic resonance angiography of the aorta and its branches and was initially diagnosed with type IIb TA. She was put on prednisolone and methotrexate but had a major relapse with new-onset lower limb claudication despite an appropriate course of immunosuppression. She was planned for tocilizumab infusion 8 mg/kg intravenous every 4 weeks. Following the first dose of tocilizumab, her vascular symptoms improved but she had a flare of PG. This was followed by another flare after the second dose. She was switched to tofacitinib which led to sustained remission of her TA activity and healing of her skin lesions, and the prednisolone dose could be reduced to 5 mg daily over the next 1 year. Various immunosuppressives were used to date for treating PG in TA. However, tofacitinib is being reported for the first time in literature for treating PG and controlling TA activity. The paradoxical flare of PG with tocilizumab is quite uncommon and is also reported in our case with literature review..

Medienart:

E-Artikel

Erscheinungsjahr:

2023

Erschienen:

2023

Enthalten in:

Zur Gesamtaufnahme - volume:42

Enthalten in:

Clinical rheumatology - 42(2023), 5 vom: 13. Jan., Seite 1469-1477

Sprache:

Englisch

Beteiligte Personen:

Bhowmick, Kaustav [VerfasserIn]
Roongta, Rashmi [VerfasserIn]
Dey, Soumya [VerfasserIn]
Dey, Sonali [VerfasserIn]
Mondal, Sumantro [VerfasserIn]
Sinhamahapatra, Pradyot [VerfasserIn]
Ghosh, Parasar [VerfasserIn]
Ghosh, Biswadip [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

BKL:

44.00$jMedizin: Allgemeines

44.83$jRheumatologie$jOrthopädie

Themen:

Pyoderma gangrenosum
Refractory
Takayasu arteritis
Tofacitinib

Anmerkungen:

© The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR) 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

doi:

10.1007/s10067-023-06506-x

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2134429135

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