A Fatal Case of Pyoderma Gangrenosum Refractory to Multiple Systemic Therapies

Ulcerative pyoderma gangrenosum (PG) is characterized by proliferative, necrotic, deep, and undermined ulcers that occur either singly or as multiple lesions on the lower extremities of the body.We report the case of a 68-year-old man who was initially treated for a diabetic ulcer.However, based on the characteristic clinical features, including pathergy, severe pain, and edematous erythema surrounding the ulcers, a diagnosis of PG was established.Systemic corticosteroids were not administered because of patientspecific factors.Alternative systemic therapies, including adalimumab, granulocyte and monocyte adsorption apheresis, and cyclosporine, were sequentially initiated.However, disease control was not achieved, and his condition progressively worsened, thus resulting in death 14 months after the initial presentation and approximately 26 months after the disease onset.PG demonstrates a broad spectrum of severity, ranging from mild, self-limiting disease to severe, potentially fatal presentations.Because diagnostic uncertainty often delays treatment initiation, the early recognition of PG and prompt initiation of appropriate systemic therapy are critical, particularly in cases of progressive and refractory ulcers.