A 63-year-old man with chronic lymphocytic leukaemia developed pyoderma gangrenosum following minor trauma to the leg. He required intensive inpatient management with a multitude of treatments including larval therapy, surgical debridement, ciclosporin, methotrexate, thalidomide, pulsed intravenous methylprednisolone and high-dose intravenous immunoglobulin, clofazamine and high dose oral corticosteroids, none of which were helpful. Treatment complications included steroid-induced diabetes, Cushing's syndrome and perforated peptic ulcer. The pyoderma remained refractory to treatment and continued to extend until he received intravenous infliximab 5 mg/kg at weeks 0, 2 and 6.
We describe the clinical course of a patient with mixed cryoglobulinaemia and multisystem disease over a 21-year period. She consistently tested negative for hepatitis C virus (HCV) serology, but active HCV infection (genotype Ia) was confirmed using reverse transcription-polymerase chain reaction. After initial improvement following treatment with interferon-alpha and ribavirin, unfortunately she developed severe neutropenia necessitating discontinuation of both drugs within 4 weeks. She died 1 month later.
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