{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:02:33Z","timestamp":1756339353640,"version":"3.44.0"},"reference-count":20,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,4,13]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:p>Although prednisolone, granulocyte\/monocyte apheresis, calcineurin inhibitor and anti-tumour necrosis factor (TNF) therapy are generally used, no treatment strategy for inflammatory bowel disease complicated with pyoderma gangrenosum (PG) has been established yet. Herein, we present the case of a 29-year-old man with ulcerative colitis (UC) complicated with primary sclerosing cholangitis. When UC relapsed and PG developed, prednisolone and granulocyte\/monocyte apheresis were used; however, their therapeutic effects were deemed insufficient. After 2 weeks, adalimumab (ADA) induced remission; however, his UC and PG relapsed 20 weeks later. As a result of switching to infliximab, since a loss of response to ADA was deemed to have occurred, remission was reintroduced and subsequently maintained for 40 weeks. We conclude that anti-TNF-\u03b1 antibodies might be selected as the first choice when PG and UC are refractory to treatment, and a switch to anti-TNFs should be considered when the effect is still insufficient.<\/jats:p>","DOI":"10.1136\/bcr-2021-241744","type":"journal-article","created":{"date-parts":[[2021,5,6]],"date-time":"2021-05-06T12:06:44Z","timestamp":1620302804000},"page":"e241744","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Effective use of switching biologics for ulcerative colitis complicated with pyoderma gangrenosum and primary sclerosing cholangitis"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9111-8447","authenticated-orcid":false,"given":"Kenta","family":"Iwahashi","sequence":"first","affiliation":[{"name":"Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2087-8163","authenticated-orcid":false,"given":"Yuichiro","family":"Kuroki","sequence":"additional","affiliation":[{"name":"Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuichi","family":"Takano","sequence":"additional","affiliation":[{"name":"Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7773-3072","authenticated-orcid":false,"given":"Masatsugu","family":"Nagahama","sequence":"additional","affiliation":[{"name":"Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,5,6]]},"reference":[{"key":"2025082700060539000_14.5.e241744.1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1159\/000341950","article-title":"Treatment of extraintestinal manifestations in inflammatory bowel disease","volume":"86(Suppl 1)","author":"Lakatos","year":"2012","journal-title":"Digestion"},{"key":"2025082700060539000_14.5.e241744.2","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-013-2762-2"},{"key":"2025082700060539000_14.5.e241744.3","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12431"},{"key":"2025082700060539000_14.5.e241744.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4632.2004.02128.x"},{"key":"2025082700060539000_14.5.e241744.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.crohns.2010.10.006"},{"key":"2025082700060539000_14.5.e241744.6","doi-asserted-by":"crossref","first-page":"25","DOI":"10.2169\/internalmedicine.55.5422","article-title":"Pyoderma gangrenosum with ulcerative colitis successfully treated by the combination of granulocyte and monocyte adsorption apheresis and corticosteroids","volume":"55","author":"Ohno","year":"2016","journal-title":"Intern Med"},{"key":"2025082700060539000_14.5.e241744.7","article-title":"Adalimumab therapy for recalcitrant pyoderma gangrenosum","volume":"5","author":"Fonder","year":"2006","journal-title":"J Burns Wounds"},{"key":"2025082700060539000_14.5.e241744.8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2007.08212.x"},{"key":"2025082700060539000_14.5.e241744.9","doi-asserted-by":"publisher","DOI":"10.1002\/ibd.20748"},{"key":"2025082700060539000_14.5.e241744.10","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.15.2293"},{"key":"2025082700060539000_14.5.e241744.11","doi-asserted-by":"publisher","DOI":"10.1001\/archdermatol.2009.57"},{"key":"2025082700060539000_14.5.e241744.12","doi-asserted-by":"publisher","DOI":"10.1002\/ibd.21723"},{"key":"2025082700060539000_14.5.e241744.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ad.2011.04.010"},{"key":"2025082700060539000_14.5.e241744.14","first-page":"285","article-title":"Peri-ileostomy pyoderma gangrenosum. 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