PMC7136808_01
Ulcerations on initial presentation. (a) Vertex of the scalp. (b) Base of the posterior neck. (c) Right lower extremity. (d) Left lower extremity.
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He had multiple wounds with serosanguineous drainage: ulcer at the vertex of the scalp measured 7 cm x 3 cm, posterior neck ulceration 5 cm x 2 cm, and multiple ulcers, of varying stages, circumferentially on bilateral lower extremities (Figure 1).
(a) X-ray of the left hand with erosive changes at the 5th PIP joint. (b) X-ray of the right hand with erosive changes at the 2nd and 4th PIP joints.
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X-ray of bilateral hands revealed marginal erosions at the right second and fourth PIP joints and left 5th PIP joint (Figure 2).
CT enterography revealing jug-like syndesmophytes at T12 and L1, suggestive of spondyloarthropathy.
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T12 and L1 with sclerosis at the sacroiliac joints (Figure 3). The gastroenterology team planned on completing a repeat colonoscopy as an outpatient as pyoderma gangrenosum can precede inflammatory bowel disease.
(a, b) Bilateral lower extremities prior to adalimumab initiation. (c, d) Bilateral lower extremities 4 weeks after Adalimumab treatment.
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Within four weeks, there was significant improvement (Figure 4).