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UEG Week Berlin 2025 Recordings Gut Guide online

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Clinical Case Summary

Introduction: Infliximab, an anti-TNF agent, has revolutionized the management of inflammatory bowel disease (IBD), promoting long-term remission and improving quality of life. However, paradoxical immune-mediated reactions, including autoimmune dermatologic conditions, have been increasingly recognized.
Aims & Methods: We report a rare case of paradoxical development of giant pyoderma gangrenosum (PG) in a patient with Crohn’s disease during Infliximab maintenance therapy.
Case Report: A 26-year-old female with Crohn’s disease (A2, L3, B1), in clinical remission under Infliximab, developed a pustular erythematous nodule (~5 cm) on the right popliteal region after the third maintenance dose. The lesion rapidly expanded to a painful ulcerative plaque with inflammatory borders, reaching 15 cm in diameter within 8 days. Histopathology revealed dense neutrophilic dermatosis, confirming pyoderma gangrenosum.
Results: This case exemplifies a paradoxical reaction induced by anti-TNF therapy. Although PG is more commonly associated with ulcerative colitis, it may occur in Crohn’s disease and be exacerbated by immunomodulation. The lesion was managed with corticosteroids and discontinuation of Infliximab, with partial improvement.
Conclusion: Paradoxical PG during anti-TNF therapy is rare but significant. Clinicians should be alert to unusual dermatologic manifestations in IBD patients on biologics. Early recognition and multidisciplinary management are essential to mitigate morbidity.

References

1) Paradoxical pyoderma gangrenosum induced by infliximab in a patient with Crohn’s disease.
• Autores: Llamas-Velasco M, García-Diez A, Daudén E.J Crohns Colitis. 2013;7(10):e479-81.
2) Paradoxical skin reactions to anti-TNFα agents: a study of 118 cases.
• Autores: Ramos-Casals M, Brito-Zerón P, Muñoz S, Soto MJ.Br J Dermatol. 2010;163(5):1159-65.
3) Paradoxical psoriasis and pyoderma gangrenosum induced by anti-TNF therapy in inflammatory bowel disease: a case series.
• Autores: Navarini AA, Trüeb RM, Imhof L, French LE.J Crohns Colitis. 2011;5(5):457-62.