We report a case of successful combined therapy for rapidly progressive pyoderma gangrenosum (PG). A 78 year old woman was admitted to the department of rheumatology with large right leg skin ulcers affecting the anterior and mediolateral lower shin region (fig 1A). The lesions had developed from small pustules to a focus of large painful skin damage during the past month. Her past history was free of any skin disease. Arterial hypertension, depression, and osteoporosis were controlled with permanent treatment. Her laboratory findings were unremarkable, including negative hepatitis B surface antigen and hepatitis C virus and normal liver function.