Pyoderma gangrenosum in rheumatoid arthritis treated with combined immunomodulatory and antimicrobial therapy: A case report

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by painful, necrotic ulcers that often affect extremities. It typically occurs between the third and sixth decades and affects both sexes equally. PG is frequently associated with systemic inflammatory diseases, particularly rheumatoid arthritis (RA), with several studies indicating a strong link between the two conditions. While the association is known, cases demonstrating successful management of refractory PG using a multi-modal Janus kinase (JAK)-inhibitor approach in the setting of hematological complications are sparse. We report the case of a 70-year-old Indian woman with RA who developed PG on her lower limbs. She was successfully treated with a combination of tofacitinib, sulfasalazine, doxycycline, dapsone, and topical 0.1% tacrolimus ointment. This case highlights the association between PG and RA and demonstrates the benefit of immunomodulatory therapy in managing such cases.