Access Dermatology

History

A 68-year-old woman presented with a 2-week history of painful, rapidly enlarging oral lesions, noticed one week after the laser surgery of her right eye. Her medical history was significant for pyoderma gangrenosum, which was first diagnosed 5 years ago when the patient presented with ulcers on the dorsal aspects of both hands. Immunosuppressive therapy with oral corticosteroids and ciclosporin provided a rapid healing of ulcers. Despite maintaining immunosuppressive treatment, 2 years later, she had a short episode of ulcerating esophagitis, and a year later she re-presented with an ulcer involving her left medial malleolus. She responded well to the combined immunosuppressive therapy, including prednisolone 12.5 mg/day, ciclosporin 100 mg/day and mycophenolate mofetil 1500 mg/day. During the last 2 years, the doses of immunosuppressants were reduced to 10 mg/day prednisolone and 500 mg/day mycophenolate mofetil with no recurrence of skin lesions. The patient was continuously followed-up for possible underlying disorders. Moreover, a year ago, a sensomothoric polyneuropathy as a result of degenerative spinal disease was diagnosed. In addition, she had a history of dyslipidemia and hypertension and was regularly taking simvastatin and enalapril.