The diagnostic and therapeutic challenges of pyoderma gangrenosum in a 32-year-old woman with systemic lupus erythematosus: a case report.

Introduction and importance: The occurrence of (PG) in the context of systemic lupus erythematosus (SLE) can be challenging to diagnose and might complicate disease management and affect patient outcomes. This case report aims to add evidence on PG occurring during inactive SLE and highlights the role of tumor necrosis factor alpha inhibition in refractory cases where conventional therapy failed. Case presentation: A 32-year-old woman with an 8-year history of SLE presented with multiple painful, necrotic ulcers over both lower limbs. Diagnosis was based on clinical presentation, exclusion of infections, and vasculitis. Significant improvement was observed following the initial treatment with high-dose prednisolone (50 mg daily). Nevertheless, reducing the dosage to 7.5 mg per day exacerbated the lesion. Following an unsatisfactory response by prednisolone, azathioprine at a daily dose of 150 mg, and mycophenolate mofetil at a daily dose of 2 g, etanercept (25 mg every other week) was administered. Administration of 25 mg of etanercept for a period of 3 months resulted in satisfactory healing of the ulcers. Clinical discussion: This case highlights the complexities of diagnosing and managing PG in the context of SLE, particularly in patients with inactive lupus. The treatment journey underscores the importance of individualized therapeutic strategies, including the potential use of biologic agents like etanercept in refractory cases. It also sheds light on maintenance of initial corticosteroid therapy and reconsideration of early dose tapering. Conclusion: Some uncommon and challenging presentation of pyoderma gangrenosum in a SLE patient may require an appropriate, individualized management.