Figure 1:

a) Our patient’s clinical history was significant for recurrent episodes of purulent otitis media, polyarticular juvenile idiopathic arthritis (JIA), two episodes of pyogenic sterile arthritis and osteomyelitis of the right elbow, and various cutaneous manifestations including recurrent episodes of cellulitis and abscesses, pyoderma gangrenosum (PG), and nodulocystic acne. Arrows indicate initiation of adalimumab and addition of tacrolimus. * represents PG flare during lapse of adalimumab therapy for 6–8 weeks. b) Dermatopathology from biopsy of left breast lesion revealed a mixed lobular panniculitis with interstitial neutrophils and lymphocytes and features consistent with a neutrophilic dermatosis. c) Erythematous, violaceous ulcerated plaque that represents PG lesion prior to treatment. d) PG lesion following treatment with adalimumab with reduction in erythema, ulceration, and size. e) PG lesion following addition of tacrolimus to adalimumab has healed into a hypertrophic scar.