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.