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Abstract Details

It's Not Always An Infection: Pyoderma Gangrenosum of the Urogenital Tract in Two Patients with Multiple Sclerosis Treated with Rituximab
Multiple Sclerosis
P6 - Poster Session 6 (12:00 PM-1:00 PM)
9-010
Rituximab, a B-cell depleting therapy used in the treatment of Multiple Sclerosis (MS), has been associated with pyoderma gangrenosum (PG). PG is an inflammatory, ulcerative, skin disease of unclear etiology. Rare cases of extracutaneous PG causing vulvovaginal ulcerations have been described in rituximab treated patients with lymphoma.
To characterize extracutaneous PG, a rare complication among rituximab treated MS patients
Chart review of 184 rituximab treated patients between 2013 to 2019
Case 1: 27-year-old with a 6 year history of MS, on rituximab (1000 mg x 2, 14 days apart every 6 months) for 3 years due to disease progression despite other disease modifying agents (DMTs). Patient presented with vaginal ulceration, discharge, and fever. Biopsy of the vaginal lesion revealed marked acute and chronic inflammation consistent with PG. MRI of the pelvis revealed a complex perianal fistula. She underwent bilateral salpingectomy, appendectomy, peritoneal abscess drainage; no infectious process was identified. Case 2: 25-year-old diagnosed with MS at age 16 on rituximab (1,000 mg every 6 months), for 7 years following disease progression on multiple other DMTs. He presented with urinary retention, diarrhea, and fever. An abscess of the gluteal fold with a fistula tract to pelvis was present. MRI revealed multiple abscesses in the pelvis, prostate, urethra, kidney & perinephric regions. Microbiology cultures were negative. Prostate biopsy revealed ulceration with marked acute inflammation and granulation formation. Discussion: The PG diagnosis for both cases was supported by the persistent fever, sterile neutrophilia and leukocytosis in the absence of an infectious agent and despite antibiotic and antifungal coverage. The diagnosis was further confirmed on biopsy and by the dramatic improvement following prednisone and five days of IVIG once this therapy was initiated.
Extracutaneous PG can occur in MS patients on rituximab, involve multiple urogenital organs and responds to steroids and IVIG.
Authors/Disclosures
Erica Hailey Parrotta, DO (Saint Peters Health Partners MS & Headache Center)
PRESENTER
No disclosure on file
Lana Zhovtis Ryerson, MD (Jersey Shore University Medical Center) Dr. Zhovtis Ryerson has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Zhovtis Ryerson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Zhovtis Ryerson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Zhovtis Ryerson has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Zhovtis Ryerson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Zhovtis Ryerson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Zhovtis Ryerson has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Dr. Zhovtis Ryerson has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. The institution of Dr. Zhovtis Ryerson has received research support from Biogen. The institution of Dr. Zhovtis Ryerson has received research support from Genentech.
Lauren B. Krupp, MD, FAAN (NYU Langone Medical Center) Dr. Krupp has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Krupp has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Krupp has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Krupp has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gerson Lerhman. Dr. Krupp has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for medscape. Dr. Krupp has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NeuroLive. Dr. Krupp has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Krupp has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Krupp has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Krupp has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Cleveland Clinic. Dr. Krupp has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for MCIC. The institution of Dr. Krupp has received research support from Biogen. The institution of Dr. Krupp has received research support from National Multiple Sclerosis Society. Dr. Krupp has received intellectual property interests from a discovery or technology relating to health care.