Intralesional Corticosteroids as Adjunctive Therapy for Refractory Cutaneous Lesions in Chronic Granulomatous Disease

Chronic granulomatous disease (CGD) arises from defects in the reduced nicotinamide adenine dinucleotide phosphate-oxidase complex leading to defective phagocyte killing. Given the histopathology findings, clinical persistence despite aggressive systemic therapy and noting that other neutrophilic skin conditions are commonly treated with adjunctive intralesional glucocorticoids, we initiated intralesional therapy in our patient.1 He received 3 separate triamcinolone acetonide injections, 60 mg at concentration 20 mg/1 mL, 85 mg and 80 mg at varying concentrations of 20 mg/1 mL and 10 mg/1 mL, respectively, in multiple open lesions at 8-week intervals. Inflammatory complications in CGD necessitate the use of immunomodulation in conjunction with antimicrobial therapy for disease control.2 Furthermore, precedence exists for using intralesional glucocorticoid therapy to treat refractory lesions in other granulomatous diseases such as idiopathic granulomatous cheilitis and sarcoidosis.