Ulcerative pyoderma gangrenosum in a 78-year-old woman treated with brodalumab: A case report

Pyoderma gangrenosum is a rare neutrophilic dermatosis, that is, often recalcitrant to conventional therapies. Biologics targeting specific inflammatory pathways, including IL-17, are emerging as alternative treatment options in refractory cases. We report a case of severe, ulcerative pyoderma gangrenosum in a 78-year-old woman with complex comorbidities, including advanced sarcoma and prior venous thromboembolism, which precluded use of several immunosuppressive agents. The patient was refractory to corticosteroids, dapsone, and roflumilast, and developed recurrent Gram-negative infections. Initiation of brodalumab, an anti-IL-17RA monoclonal antibody, led to rapid ulcer improvement and sustained clinical response, with successful tapering of systemic steroids. Brodalumab may offer a safe and effective treatment option in refractory pyoderma gangrenosum, particularly in patients with contraindications to conventional therapies. This case supports further evaluation of IL-17 pathway inhibition in neutrophilic dermatoses.