Successful treatment of pyoderma gangrenosum with concomitant immunoglobulin A nephropathy: A case report and review of literature

ARTICLE HIGHLIGHTS

Case characteristics

A 20-year-old female with pyoderma gangrenosum (PG) with concomitant immunoglobulin A (IgA) nephropathy was successfully treated.

Clinical diagnosis

According to the laboratory results and clinical manifestations, nephric syndrome and PG were diagnosed.

Differential diagnosis

Skin infections should be excluded.

Laboratory diagnosis

High proteinuria (13 g/24 h), hypoalbuminemia (16 g/L) and hyperlipidemia suggested nephrotic syndrome.

Imaging diagnosis

Abdominal ultrasound indicated normally sized kidneys and massive ascites.

Pathological diagnosis

Renal biopsy showed IgA nephrology, with stronger staining (3+) for IgA and C3 in the mesangial area, and skin biopsy indicated massive small lymphocytes arranged around blood vessels throughout the dermis, suggesting vasculitis.

Treatment

Prednisolone at 1 mg/kg plus cyclophosphamide at 0.6 mg/2wk, followed by prednisone at 5 mg/kg plus cyclosporine A (CsA) at 3 mg/(kg∙d) (75 mg b.i.d.).

Related reports

There are no reports of coexistence of PG and IgA nephropathy. This is the first reported case of PG with concomitant IgA nephropathy to be successfully treated.

Term explanation

PG and IgA nephropathy are both autoimmune diseases.

Experiences and lessons

Low-dosage prednisone (5 mg/kg) plus CsA may be helpful in patients with PG concomitant with IgA nephropathy.