Resolution of Severe Pyoderma Gangrenosum in a Patient with Streaking Leukocyte Factor Disease after Treatment with Tacrolimus (FK 506)
Authors: Kareem Abu-Elmagd
Journal: Annals of Internal Medicine (1993)

Brief Reports1 October 1993Resolution of Severe Pyoderma Gangrenosum in a Patient with Streaking Leukocyte Factor Disease after Treatment with Tacrolimus (FK 506)Kareem Abu-Elmagd, MD, David H. Van Thiel, MD, Brian V. Jegasothy, MD, Jerry C. Jacobs, MD, Patricia Carroll, MD, Horacio Rodriquez-Rilo, MD, Cheryl D. Ackerman, MD, John J. Fung, MD, PhD, and Thomas E. Starzl, MD, PhDKareem Abu-Elmagd, MDFrom the Pittsburgh Transplant Institute and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Columbia University College of Physicians and Surgeons, New York, New York.Search for more papers by this author, David H. Van Thiel, MDFrom the Pittsburgh Transplant Institute and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Columbia University College of Physicians and Surgeons, New York, New York.Search for more papers by this author, Brian V. Jegasothy, MDFrom the Pittsburgh Transplant Institute and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Columbia University College of Physicians and Surgeons, New York, New York.Search for more papers by this author, Jerry C. Jacobs, MDFrom the Pittsburgh Transplant Institute and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Columbia University College of Physicians and Surgeons, New York, New York.Search for more papers by this author, Patricia Carroll, MDFrom the Pittsburgh Transplant Institute and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Columbia University College of Physicians and Surgeons, New York, New York.Search for more papers by this author, Horacio Rodriquez-Rilo, MDFrom the Pittsburgh Transplant Institute and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Columbia University College of Physicians and Surgeons, New York, New York.Search for more papers by this author, Cheryl D. Ackerman, MDFrom the Pittsburgh Transplant Institute and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Columbia University College of Physicians and Surgeons, New York, New York.Search for more papers by this author, John J. Fung, MD, PhDFrom the Pittsburgh Transplant Institute and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Columbia University College of Physicians and Surgeons, New York, New York.Search for more papers by this author, and Thomas E. Starzl, MD, PhDFrom the Pittsburgh Transplant Institute and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Columbia University College of Physicians and Surgeons, New York, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-119-7_Part_1-199310010-00008 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Severe, lifelong, unresolving pyoderma gangrenosum occurs in association with recurrent episodes of sterile pyoarthrosis and the presence of a serum factor (called streaking leukocyte factor) [1] responsible for enhancing random migration of purified human neutrophils and mononuclear leukocytes in vitro. Pyoderma gangrenosum is only one feature of this unusual disease. Minor trauma of any sort leads to an excessive accumulation of both mononuclear and polymorphonuclear leukocytes in tissue. This causes subcutaneous induration, sterile abscesses, sterile pyoarthrosis, and extensive areas of skin necrosis similar to those occurring in classical pyoderma gangrenosum, except that the lesions are larger and more confluent. The ...References1. Jacobs JC, Goetz EJ. Streaking leukocyte factor, arthritis, and pyoderma gangrenosum. Pediatrics. 1975; 56:570-8. Google Scholar2. Kino T, Hatanaka H, Hashimoto M, Nishiyama M, Goto T, Okuhara M, et al. FK-506 a novel immunosuppressant isolated from a Streptomyces. I. Fermentation, isolation and physio-chemical and biological characteristics. J Antibiot. 1987; 40:1249-55. Google Scholar3. Tamura K, Kobayashi M, Hashimoto K, Kojima K, Nagase K, Iwasaki K, et al. A highly sensitive method to assay FK-506 levels in plasma. Transplant Proc. 1987; 19:23-9. Google Scholar4. Fung JJ, Alessiani M, Abu-Elmagd K, Todo S, Shapiro R, Tzakis A, et al. Adverse effects associated with the use of FK 506. Transplant Proc. 1991; 23:3105-8. Google Scholar5. Jacobs JC. Pediatric Rheumatology for the Practitioner. New York: Springer, Verlag, 1993:153-7. Google Scholar6. Maderazo EG, Woronick CL, Ward PA. Leukokinesis-enhancing factor in human serum: partial characterization and relationship to disorders of leukocyte migration. Clin Immunol Immunopathol. 1979; 12:382-95. Google Scholar7. Ketchel MM, Farour CB, Sturgis SH. The in vitro action of hydrocortisone and leukocyte migration. J Exp Med. 1958; 107:211. Google Scholar8. Ward PA. The chemosuppression of chemotaxis. J Exp Med. 1966; 124:209-26. Google Scholar9. Martin RR, Warr GA, Couch RB, Yeager H, Knight V. The effects of tetracycline on leukotaxis. J Infect Dis. 1974; 129:110-6. Google Scholar10. Kino T, Hatanaka H, Miyata S, Inamura N, Nishiyama M, Yajima T, et al. FK-506, a novel immunosuppressant isolated from a Streptomyces. II. Immunosuppressive effect of FK-506 in vitro. J Antibiot. 1987; 40:1256-65. Google Scholar11. Todo S, Fung JJ, Starzl TE, Tzakis A, Demetris AJ, Kormos R, et al. Liver, kidney, and thoracic organ transplantion under FK 506. Ann Surg. 1990; 212:295-307. Google Scholar12. Jegasothy BV, Ackerman CD, Todo S, Fung JJ, Abu-Elmagd K, Starzl TE. Tacrolimus (FK 506)a new therapeutic agent for severe recalcitrant psoriasis. Arch Dermatol. 1992; 128:781-5. Google Scholar13. Abu-Elmagd K, Jegasothy BV, Ackerman CD, Thomson AW, Rilo H, Nikolaidis N, et al. Efficacy of FK 506 in the treatment of recalcitrant pyoderma gangrenosum. Transplant Proc. 1991; 23:3328-9. Google Scholar14. Wilkinson PC, Watson EA. FK 506 and pertussis toxin distinguish growth-induced locomotor activation from attractant-stimulated locomotion in human blood lymphocytes. Immunology. 1990; 71:417-22. Google Scholar15. Glass AT, Bancila E, Milgraum S. Pyoderma gangrenosum in infancy: the youngest reported patient. J Am Acad Dermatol. 1991; 25:109-10. Google Scholar Author, Article, and Disclosure InformationAuthors: Kareem Abu-Elmagd, MD; David H. Van Thiel, MD; Brian V. Jegasothy, MD; Jerry C. Jacobs, MD; Patricia Carroll, MD; Horacio Rodriquez-Rilo, MD; Cheryl D. Ackerman, MD; John J. Fung, MD, PhD; Thomas E. Starzl, MD, PhDAffiliations: From the Pittsburgh Transplant Institute and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Columbia University College of Physicians and Surgeons, New York, New York.Corresponding Author: Kareem Abu-Elmagd, MD, Pittsburgh Transplant Institute, 3601 Fifth Avenue, Falk Clinic 5C, Pittsburgh, PA 15213.Acknowledgments: The authors thank Drs. Ramadan Sha'afi and Kozo Yasui for their help and technical assistance in measuring the serum factor. They also thank Nancy Johnson for patient care and Sharon Wesolowski for preparing the manuscript.Grant Support: In part by research grants from the Veterans Affairs and grant DK29961 from the National Institutes of Health, Bethesda, Maryland PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byClinical and Genetic Findings of the First Report of PAPA Syndrome in BrazilPyoderma gangrenosum: From historical perspectives to emerging investigationsBrief Report: Genotype, phenotype, and clinical course in five patients with PAPA syndrome (pyogenic sterile arthritis, pyoderma gangrenosum, and acne)Pyoderma gangrenosum (2 ème partie) : manifestations buccales et présentation d’un casPyoderma gangrenosum (1 ère partie) : mise au pointManagement des Pyoderma gangraenosumComposite tissue allotransplantation: a review of relevant immunological issues for plastic surgeonsTopical tacrolimus in the treatment of perianal Crohnʼs diseaseTreatment recommendations for pyoderma gangrenosum: An evidence-based review of the literature based on more than 350 patientsTopical tacrolimus (FK506) in the treatment of recalcitrant parastomal pyoderma gangrenosum associated with Crohn's disease: report of two casesNeutrophilic dermatosesVaskulitisClinical Management of Pyoderma GangrenosumTacrolimus clinical studies for atopic dermatitis and other conditionsTacrolimus in Dermatologic DisordersTacrolimusCYCLOSPORINE AND TACROLIMUS IN DERMATOLOGYA Rationale for Adjuvant Surgical Intervention in Pyoderma GangrenosumTacrolimus: pharmacology and therapeutic uses in dermatologyTacrolimus (FK 506)Recalcitrant pyoderma gangrenosum treated with systemic tacrolimusPlasmapheresis and cyclophosphamide as successful treatments for pyoderma gangrenosumKoebner Phenomenon in an ANCA-Positive Patient with Pyoderma GangrenosumPyoderma gangrenosum in myclodysplasia responding to granulocyte macrophage-colony stimulating factor (GM-CSF)Pyoderma GangrenosumChlorambucil is an effective corticosteroid-sparing agent for recalcitrant pyoderma gangrenosumTreatment of pyoderma gangrenosum 1 October 1993Volume 119, Issue 7_Part_1Page: 595-598KeywordsBlood plasmaBlood urea nitrogenCreatinineDrugsGlucoseImmunosuppressivesLesionsNeutrophilsPyodermaUlcers ePublished: 15 August 2000 Issue Published: 1 October 1993 Copyright & PermissionsCopyright © 1993 by American College of Physicians. 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