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P149. Pyoderma gangrenosum in adult IBD patients: Prevalence, risk factors and therapeutic control

L. Gheorghe1, R. Cerban1, R. Vadan1, C. Toader1, C. Gheorghe1, C. Cotruta2

1Fundeni Clinical Institute, Gastroenterology and Hepatology Center, Bucharest, Romania; 2Dermashape Medical and Surgical Dermatology Clinic, Bucharest, Romania

Background: Pyoderma gangrenosum (PG) is a neutrophilic dermatitis frequently associated with IBD. Previous studies have suggested that IBD-associated PG is usually associated with ulcerative colitis and mild disease. The aim of this study was to investigate the prevalence and risk factors for IBD-associated PG in adult patients.

Methods: We reviewed systematic all IBD-associated PG cases registered in IBD Database at the Fundeni Center for Digestive Diseases, a tertiary referral center from Bucharest, between January 2008 and January 2011. This is a comprehensive electronic database prospectively collecting IBD patients admitted to our gastroenterology department. Chart information of all IBD-associated PG cases were further verified and analyzed.

Results: The total number of patients on the IBD Database at 1st October 2011 was 463, 211 patients with ulcerative colitis and 252 patients with Crohn's disease. PG was recorded in 12 patients, leading to a prevalence figure of 2.59. Average age at PG diagnosis was 35 (range: 20–59) and at IBD diagnosis was 31 (range: 14–48). No cases of PG were diagnosed at the onset of IBD, all appearing later in disease's evolution (after a mean of 3.78 years), all cases during flares of diseases' activity. In our study IBD-related PG was associated with Crohn's disease in the majority of cases (91.66%) and rarely with ulcerative colitis (only one case); PG was associated with female gender (75%), ileo-colonic involvement (66.6%), and with severe disease (58.3%). All patients but one responded to increasing immunosupression (adding-on or escalating therapy with immunomodulators or biologics). A very severe case of IBD-associated PG of the limbs in a 36-yr-old Crohn's disease female patient occuring during infliximab therapy and requiring dose intensification, corticosteroids and local therapy (intralesional cortisone, hydrocolloid patches) is further presented.

Conclusions: In contrast with the data from literature the majority of IBD-associated PG cases in our study were seen in patients with Crohn's disease and during flares of activity. Effective therapy consisted in immunosuppression intensification over a prolonged period of time. Severe cases required dermatologist's expertise for concomitant local therapy.