Idiopathic pyoderma gangrenosum and impaired lymphocyte function: failure of azathioprine and corticosteroid therapy

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Abstract
A 58 yr old man with chronic idiopathic pyoderma gangrenosum, recurrent secondary staphylococcal infection, nail candidiasis [moniliasis], markedly impaired lymphocyte function and a serum blocking factor is described. Despite an initially favorable response to immunosuppressive therapy, the patient later relapsed whilst on high dose systemic corticosteroids and azathioprine. Immune function remains abnormal 3 yr after cessation of azathioprine. Attempted immunostimulation with Corynebacterium parvum [Propionibacterium acnes] proved unsuccessful. A striking but transient increase in lymphocyte function followed parenteral Fe therapy for an unexplained Fe-deficiency anemia. Gradual reduction in prednisone dosage to 5 mg daily has coincided with a period of clinical resolution and modest improvement in lymphocyte reactivity. Prolonged immunosuppressive therapy may be inadvisable in chronic idiopathic pyoderma gangrenosum associated with defective cellular immunity.