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PubMed2001

[A case of pyoderma gangrenosum after mitral valve replacement].

A 48-year-old male with treated hypothyroidism underwent mechanical valve replacement for mitral valve regurgitation. After the operation, the patient developed progressive median chest wound ulceration. The wound did not heal with conventional therapies for mediastinitis such as administration of antibiotics, debridement of necrotic tissue or continuous irrigation. The entire surgical wound opened spontaneously. Bacterial cultures yielded negative and the wound biopsy specimen revealed non-specific inflammatory change. The anti-TSH receptor antigen level was high. Pyoderma gangrenosum based on auto-immune deficiency was diagnosed and high dose corticosteroid therapy was started. The wound healed completely in 5 months.

Autoantibodies↗
PubMed2001

[Postoperative pyoderma gangrenosum developing after cholecystectomy and placement of a stoma].

Pyoderma gangrenosum is a serious necrotizing skin disease frequently associated with diseases of internal organs. In rare instances it may develop after surgical operations or minor injuries causing traumatization of the skin. Our patient developed the disease immediately after cholecystectomy at the site of the scar on the abdomen, and disseminated foci developed also at other sites of the body. In the second patient it developed in the region of the stoma soon after its establishment during development of ulcerative colitis. Skin manifestations healed after systemic combined immunosuppressive treatment.

Adult↗
PubMed2000

Pyoderma gangrenosum: a case study for pain management in dermatology nursing.

The Joint Commission on Accreditation of Healthcare Organizations recently approved new standards for pain assessment and management. These standards will influence the practice of dermatology nursing in every setting. Nurses play a critical role in the care of patients with pain. Pyoderma gangrenosum is used as the basis for applying the new pain standards.

Acetaminophen↗
PubMed2001

[Ulcerative colitis concomitant with pyoderma gangrenosum and erythema nodosum--presentation of two cases].

Authors present case of a 28-year old woman with skin symptoms of pyoderma gangrenosum and ulcerative colitis seriously advanced. The patient benefited from wide resection of the colon and steroid therapy. The other patient was 23-year old woman with ulcerative colitis concomitant with skin changes of erythema nodosum. In this case steroid therapy gave also a very good effect. We tried to find pathogenetic connection between these diseases based on the reports from the medical literature.

Adult↗
PubMed2002

Parastomal pyoderma gangrenosum: a case report and literature review.

Parastomal pyoderma gangrenosum (PPG) is an exceedingly rare disease process most often observed in inflammatory bowel disease patients with an ileostomy. Fewer than 50 cases have been reported in the medical literature. The incidence is 0.6 per cent of patients with ileostomy and inflammatory bowel disease. The rarity of the disease leads to misdiagnosis and mistreatment of the lesion. The intense pain and disruption of ostomy function greatly impair affected individuals beyond the limit of their underlying disease. Current best care practices observed in small study series indicate long-term intensive medical therapy aimed at systemic disease suppression to optimize PPG wound healing. Our patient had no signs of active Crohn disease at the time of PPG presentation. She was initially treated with minimal wound debridement and intralesional triamcinolone. Finally under the care of an enterostomal/wound care therapist the patient achieved excellent PPG resolution in 6 months.

Adult↗
PubMed2002

Clinical analysis of 12 cases of pyoderma gangrenosum.

Twelve cases of pyoderma gangrenosum is reported in light of the clinical data including the patients' gender, age, complications, laboratory examinations, treatment and outcome, in an attempt to explore the pathogenesis, treatment and prognosis of the disease.

Adolescent↗
PubMedDate not supplied

Anti-tumor necrosis factor alpha monoclonal antibody (infliximab) for the treatment of Pyoderma gangrenosum associated with Crohn's disease.

Here we report a case of Pyoderma gangrenosum (PG) associated with Crohn's disease successfully treated with infliximab. The efficacy of this drug in many inflammatory diseases has already been reported, but its use in PG has only been seen in very few cases. Our study confirms that this therapy is a valid alternative solution for treating PG, which is often unresponsive to conventional therapies.

Antibodies, Monoclonal↗
PubMed1992

[Peristomal pyoderma gangrenosum after colectomy for Crohn disease. Successful medical treatment].

A case of Pyoderma gangrenosum with two different abdominal sites in a female patient suffering from colonic Crohn's disease is presented. Local trauma on the midline scar of an incisional hernia and around the stoma were the possible triggering factors. Despite the major abdominal wall defect and an infected parietal collection, steroid therapy was very effective without the need for surgery.

Aged↗
PubMed2003

Isolated foot ulcer complicating acute leukemia: an unusual manifestation of herpes simplex virus infection simulating pyoderma gangrenosum.

An isolated foot ulcer developed in a child with newly diagnosed acute mixed lineage leukemia during induction chemotherapy. Despite its clinical resemblance to pyoderma gangrenosum, herpes simplex virus infection was eventually diagnosed on histopathology. Treatment with oral acyclovir was ineffective, but the ulcer healed with intravenous acyclovir followed by oral valaciclovir. Viral infection remains an unusual but important cause of isolated extragenital cutaneous ulceration in the immunocompromised child.

Acyclovir↗
PubMed2003

Crohn's disease of the penis masquerading as pyoderma gangrenosum: a case report and review of the literature.

Both pyoderma gangrenosum (PG) and cutaneous (metastatic) Crohn's disease (CCD) may occur in the setting of inflammatory bowel disease (IBD). Clinical distinction between PG and CCD may be difficult because clinical and pathologic features often are similar. Although surgical debridement is therapeutic in CCD, it may lead to increased tissue loss and disease progression (pathergy) in PG. Thus, it is important to determine a definitive diagnosis before surgical debridement, especially in tissue-sensitive sites. We present a patient with chronic ulceration of the penis who ultimately was diagnosed with CCD following an initial misdiagnosis of PG.

Crohn Disease↗
PubMed2004

Clinical manifestations of pyoderma gangrenosum associated with inflammatory bowel disease.

BACKGROUND: Pyoderma gangrenosum is an uncommon ulcerative cutaneous condition associated with inflammatory bowel disease. PG occurs rarely in IBD patients and there are insufficient data on the clinical manifestations of this disease with IBD. OBJECTIVE: To determine the incidence, clinical manifestations and treatment of PG in patients with IBD and the connection to IBD, its activity and extent. METHODS: All patients hospitalized with IBD at a university hospital during a 20 year period were evaluated for the occurrence of PG. RESULTS: Of 986 patients hospitalized for IBD 6 suffered from PG (0.6% incidence). Their average age was 37 with equal sex distribution and equal distribution of Crohn's disease and ulcerative colitis. PG appeared 6.5 years on average after diagnosis of IBD in all patients. The development of PG correlated with significant clinical exacerbation of IBD, the majority having active colitis at the onset of the PG. Extraintestinal manifestations of IBD occurred in half the patients (sacroillitis, peripheral arthritis and erythema nodosum). Pathergy was not elicited in any patients. Four patients had multiple skin lesions, frequently on the lower extremities. Diagnosis was made by skin biopsy in four patients. There was little correlation between amelioration of IBD and the skin lesions. Treatment consisted of high dose steroids and immunomodulatory drugs (cyclosporine, azathioprine and dapsone) in conjunction with topical treatment. CONCLUSIONS: PG is a rare extra-intestinal manifestation of IBD that coincides with the exacerbation of the intestinal disease but does not always respond to treatment of the bowel disease.

Adult↗
PubMedDate not supplied

Atypical Behçet's disease with peripheral erosive arthropathy and pyoderma gangrenosum.

We report a 52-year-old male Caucasian who presented with a peripheral erosive arthritis, then pyoderma gangrenosum, and six years later pancolitis and orogenital ulcers. The case illustrates an overlap that may exist between Behçet's syndrome and inflammatory bowel disease. In either condition seronegative erosive peripheral joint disease is an uncommon presenting feature.

Arthritis↗
PubMed2004

Human recombinant interferonalpha-2b for management of idiopathic recurrent superficial pyoderma in dogs: a pilot study.

The oral use of human recombinant interferonalpha-2b at 1,000 IU/ml/day appeared to provide only a transient benefit as compared with placebo for management of idiopathic recurrent superficial pyoderma in dogs. Further investigation using a larger population of dogs is needed to determine whether interferon is effective for long-term treatment of this condition.

Administration, Oral↗
PubMedDate not supplied

Treatment of pyoderma gangrenosum with etanercept.

UNLABELLED: We describe a patient with pyoderma gangrenosum (PG) whose lesions responded to etanercept therapy. This disease has been recognized for diverse underlying pathology and associated immune disturbances. Although the role of cytokines in pathogenesis is not fully understood, tumor necrosis factor alpha (TNF-alpha) may facilitate induction and maintenance of the disease. This is supported by the successful use of infliximab, a recombinant anti-TNF-alpha monoclonal antibody, in cases of PG associated with inflammatory bowel disease (IBD). Etanercept is a divalent recombinant fusion protein that binds soluble TNF-alpha. To our knowledge, the utility of etanercept for PG has not been reported. A patient with recalcitrant and widespread PG that was unresponsive to systemic corticosteroids was treated with etanercept. Rapid and complete clearing of the skin lesions was observed, and steroid taper to 5 mg/day was sustained for two months. Treatment was well-tolerated with no adverse reactions reported. CONCLUSIONS: Etanercept therapy offered rapid and complete resolution of all PG lesions. Such response supports the use of etanercept as a steroid-sparing agent in recalcitrant disease and suggests the role of TNF-alpha in pathogenesis of PG.

Adult↗
PubMed2004

[Atypical pyoderma gangrenosum in 92-year-old patient].

Pyoderma gangrenosum (PG) is rather rare chronic dermatosis presenting as cutaneous necrosis followed by development of expanding chronic ulcer with well-demarcated, undermined, violaceous borders. Diagnosis of PG is predominantly based on the clinical presentation and course. Histopathologic findings may be non-specific. Half of patients suffer from a somatic systemic disease. We describe 92-year-old lady presenting with large non-healing ulcer of the anterolateral calf with the diagnosis of atypical PG. In a discussion differential diagnosis of cutaneous ulcers mimicking PG is reviewed and the treatment possibilities summarised.

Aged↗
PubMed1992

[Pyoderma gangraenosum--a rare complication after breast reduction].

Applying standardized and sound operative techniques, impaired wound healing following reduction mammoplasty is rare. A postoperative case of pyoderma gangraenosum is reported. This necrotizing skin disorder seemed at first to be a postoperative bacterial infection, but correct diagnosis was finally made histopathologically. The clinical course, etiology, diagnostic findings, and therapy are discussed and a review of the literature is presented.

Adult↗
PubMed1992

Pyoderma gangrenosum in association with erythema elevatum diutinum: report of two cases.

We report on the appearance of centrifugally spreading ulcers with undermined borders in two patients with chronic recurrent erythema elevatum diutinum controlled with dapsone. The ulcerated lesions were consistent on clinical and pathologic examination with the diagnosis of pyoderma gangrenosum. They eventually responded to treatment with oral corticosteroids. The addition of cyclosporine was required in one case. No associated disease was found in any of the patients. The possible pathophysiological mechanisms of this uncommon association are reviewed.

Adrenal Cortex Hormones↗