Rapid and sustained response to tofacitinib in a patient with anal pyoderma gangrenosum under immunosuppression and bone marrow suppression.

Aim: To evaluate the therapeutic efficacy and safety of the Janus kinase (JAK) inhibitor tofacitinib in the management of refractory perianal pyoderma gangrenosum (PG) under conditions of baseline immunosuppression and bone marrow suppression.

Methods: We present a 62-year-old male with a 4-month history of painful, progressive symmetrical perianal ulcerations diagnosed as PG, coexisting with condyloma acuminatum. The patient had a background of pure red cell aplasia and myasthenia gravis, and was undergoing chronic immunosuppressive therapy with prednisolone and tacrolimus. Previous interventions including topical agents, antibiotics, phototherapy, and surgical debridement were ineffective. Oral tofacitinib (5 mg/day) was introduced following multidisciplinary evaluation.

Results: Marked pain reduction was achieved by day two of tofacitinib therapy, with near-complete ulcer healing observed within two weeks. Hematologic parameters remained stable throughout the 4-month treatment course, which was well tolerated with no adverse effects. The patient remained relapse-free during a 1-year follow-up.

Conclusions: Tofacitinib may offer a rapid, effective, and well-tolerated treatment alternative in cases of refractory PG, even when layered onto preexisting immunosuppressive regimens. This case highlights the potential of JAK inhibitors as targeted therapy in complex PG presentations and supports their further clinical evaluation.