Abstract Details

Title It's Not Always An Infection: Pyoderma Gangrenosum of the Urogenital Tract in Two Patients with Multiple Sclerosis Treated with Rituximab

Topic Multiple Sclerosis

Presentation(s) P6 - Poster Session 6 (12:00 PM-1:00 PM)

Poster/Presentation
Number 9-010

Objective To characterize extracutaneous PG, a rare complication among rituximab treated MS patients

Background 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.

Design/Methods Chart review of 184 rituximab treated patients between 2013 to 2019

Results 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.

Conclusions Extracutaneous PG can occur in MS patients on rituximab, involve multiple urogenital organs and responds to steroids and IVIG.

Authors/Disclosures
Erica H. Parrotta, DO (Saint Peters Health Partners MS & Headache Center) PRESENTER	No disclosure on file
Lana Zhovtis Ryerson, MD, F�鶹��ýӳ�� (Jersey Shore University Medical Center)	Dr. Zhovtis Ryerson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. Dr. Zhovtis Ryerson has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi.
Lauren B. Krupp, MD, F�鶹��ýӳ�� (NYU Langone Medical Center)	Dr. krupp has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb. Dr. krupp has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Celgene. Dr. krupp has received personal compensation in the range of $500-$4,999 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 EBIX. 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 on a Scientific Advisory or Data Safety Monitoring board for Hoffman LaRoche. Dr. krupp has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for MMMK. Dr. krupp has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Patrick, Dolan, and Kaufman. Dr. krupp has received intellectual property interests from a discovery or technology relating to health care.

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