Pyoderma Gangrenosum and BC

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I have a question....skip to the bottom if that's all you want to read. Thanks.

My wife is having a severe case of what appears to be Pyoderma Gangrenosum that has not responded well to fairly high doses of prednisone and dapsone for the last two months.

She has large lesions, sometimes the size of a small grape, sometimes elongated, that are fairly deep. On the surface, they are covered with a pink patch the size of a quarter with distinct edges. They eventually ripen, a scap forms and they shrink and darken as they heal. They don't seem to totally heal. Sometimes they flare up again in the same place, more often new ones form. They can be painful, but not excessively so. They first appeared on her left tricep (same place swelling can occur due to her compromised lymph system) and then appeared on her back, neck, breasts, thighs, ankles.

She is taking 80mg/day of prednisone (which is noted in her chart as a " heavy dose " ) and 75mg/day dapsone (which the dermatologist says he has now concluded isn't having any effect). Her dermatologist also tried injecting Kenalog directly into certain more active lesions; when doing so he comments (to us, his nurse and students) that he detects " necrosis to fatty tissue " inside the lesions. That proved ineffective and has been halted.

She's been having CBC's weekly to monitor primarily her white counts (watching for infections, so far only modest evidence) and anemia (her hemoglobin count is chronically low so she's taking aranesp in order to boost her red cells.

Here's her history:

In 2000 she was diagnosed with Infiltrating Ductal Carcinoma, stage IIB or IIIA (neo-adjuvant therapy muddied assessment of tumor size). She had AC, surgery, taxol, radiation, tamoxifen. She was ER/PR positive then, minimally positive (?) now. She was HER2/neu negative then and now

In September of 2003 she had mets to spine, skull, ribs, hip, long bones, no soft tissue. She's had radiation therapy to T10-T11 andmorphine for pain management to date (and bone pain is stable). She's had an oopherectomy and takes zometa (monthly drip to boost blood counts) and

The next course of treatment is to try a modest does of cyclosporin for 7-10 days and see what happens.

Her dermatologist (or, rather, one of his students) conducted a search of the National Center for Biotechnology Information (NCBI) at the US National Library of Medicine (NLM) and produced 22 pages of abstracts, but none of them addressed Pyoderma Gangrenosum in the context of breast cancer. Rather, the abstracts generally associated Pyoderma Gangrenosum with Crohn's disease, if anything.

Here's my question: Does anyone know about any cases where Pyoderma Gangrenosum is associated with metastatic breast cancer?

Thanks for any help,

Mike McCarthy

Cincinnati