[CIS PIDD] [cis-pidd] pyoderma gangrinosum and pathergy

[CIS-PIDD]

Colleagues:

I write for help with a 14 yo girl who doesn't have PID. She has multiple
atopic diatheses (asthma, allergic rhinitis, IgE mediated food allergy,
latex allergy, FPIES and eczema). In addition to routine treatments for
these problems, she receives Xolair and has required calcineurin inhibitors
to manage eczema. She experienced DRESS syndrome and hypertension
attributed to cyclosporin A. Her eczema has been controlled with
mycophenolate. Mycophenolate has been stopped in preparation for treatment
with a TNF inhibitor (see below) causing the eczema to flare. She also has
hypoadrenalism. Her cumulative lifetime dose of glucocorticoids is high.

Because she is unable to feed enterally (she gets severe vomiting and
diarrhea with all elemental diets), she is TPN dependent. Maintaining
access for TPN has become problematic because of pyoderma gangrinosum and
pathergy around the catheter insertion sites. The immunodermatologist had
planned to use a TNF inhibitor but the drugs that have been used in
children are all packaged with latex stoppers or syringes.

The questions are:
1. Does anyone have experience with biologics useful for pyoderma
gangrinosum and pathergy that are not packaged with latex?
2. Will it be possible to use a biologic for pyoderma gangrinosum and
pathergy that will not flare the eczema?

Thank you in advance for your input.
Richard Wasserman
Dallas

-- 
Richard L. Wasserman, MD, PhD
Allergy Partners of North Texas
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211

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