Pyoderma Gangrenosum Complicated by Underlying Osteomyelitis: Successful Treatment with Radical Surgical Debridement and Cyclosporine Therapy

Pyoderma gangrenosum is a clinical entity of uncertain etiology and is characterized by painful ulcerative skin lesions that usually occur on the lower extremities or in areas of trauma. It is often, but not always, associated with systemic diseases such as rheumatoid arthritis and inflammatory bowel disease. We report a case of pyoderma gangrenosum of the leg that was unresponsive to prednisone and dapsone therapy and that became secondarily infected with Pseudomonas aeruginosa organisms that were resistant to multiple drugs. This infection resulted in limb-threatening osteomyelitis of the underlying tibia. A novel approach (cyclosporine therapy in conjunction with surgical debridement) to treatment of this disease was undertaken.