Use of etanercept in treatment of pyoderma gangrenosum in a patient with autoimmune hepatitis

Abstract

A 30-year-old female with past medical history of autoimmune hepatitis was sent to our clinic for consultation and treatment of refractory pyoderma gangrenosum (PG) of bilateral lower extremities. At the time of presentation, she had failed treatment with prednisone, azathioprine and local wound care. Treatment options were limited by the patient's autoimmune hepatitis. This patient was treated with etanercept and a taper of oral prednisone, which resulted in a complete clinical cure of her PG. More studies are needed to evaluate the safety and efficacy of etanercept for PG in patients with liver disease.

Pyoderma gangrenosum: A review and update on new therapies

“…-25 Charles et al26 report a retrospective analysis of 7 cases of PG which demonstrated an average time to complete healing of 12.5 weeks when given between 25 and 50 mg twice per week. Although one patient stopped therapy because of the side effect of cacogeusia, all 7 cases of PG…”

Drug-induced autoimmune liver disease: A diagnostic dilemma of an increasingly reported disease

“…Recently, it has been reported that at least 24 drugs, probably more, have been associated with AI chronic hepatitis mimicking AIH [67] , but more and more new agents are being implicated [67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83] . With the appearance of new statins, biologic agents, and antibiotics, it will be quite normal to see more new agents being reported as being responsible for new drug-induced AIH cases (Table 3).…”

Treatment of autoimmune liver disease: current and future therapeutic options

“…Cyclophosphamide has been evaluated in small case series and may prove useful as a salvage therapy for problematic patients [Kanzler et al 1997]. Isolated case reports exist reporting responsiveness of AIH to rituximab [Santos et al 2006] and the anti-tumour necrosis factor α (TNFα) agent etanercept [Goldenberg and Jorizzo, 2005]; however, infliximab and adalimumab have been reported to induce and exacerbate AIH [Subramaniam et al 2011;Doyle et al 2011]. Nevertheless, a marked biochemical and immunological response was observed in 11 patients with AIH (six with azathioprine intolerance or side effects and five with AIH refractory to conventional therapy) treated with infliximab, although infectious complications developed in over 63% from this group [Weiler-Normann et al 2012].…”