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PubMed2000

Pyoderma gangrenosum complicating bilateral mammaplasty.

Pyoderma gangrenosum (PG) is an idiopathic necrotising cutaneous disorder. It is associated with systemic diseases like inflammatory bowel disease, monoclonal gammopathy, arthritides and haematological malignancy. PG occurring at sites of trauma, a phenomenon called pathergy, is well described. One of the manifestations of pathergy is PG occurring at sites of surgery. We describe a case of PG at sites of reduction mammaplasty and review the literature so far.

Adult↗

PubMed2000

Pyoderma gangrenosum and myelodysplastic syndrome.

Pyoderma gangrenosum (PG) is a painful, often rapidly progressive, ulcerating skin disorder frequently associated with systemic diseases. We report the case of a patient with PG and an anemia. A bone marrow biopsy showed changes consistent with one of the myelodysplastic syndromes, refractory anemia with ringed sideroblasts. Patients with PG and anemia should have bone marrow biopsy if no cause of anemia is readily apparent.

Anemia, Refractory↗

PubMed1989

Atypical auricular pyoderma gangrenosum simulating fungal infection.

We describe a patient with a highly unusual appearance of pyoderma gangrenosum. The pyoderma was located on the auricular region and preceded other manifestations of inflammatory bowel disease by 11 years. There was no correlation between the course of the pyoderma and the clinical activity of the associated bowel disease. Mycotic superinfections masked and delayed the diagnosis in our patient for several years. Only when typical pyoderma gangrenosum lesions developed on the legs at the site of trauma and responded dramatically to systemic corticosteroids was the correct diagnosis established. Pyoderma gangrenosum with secondary fungal infection was thus distinguished from deep ulcerated skin fungal infection simulating pyoderma.

Adult↗

PubMed1988

Pyoderma gangrenosum or cutaneous lymphoma: a difficult clinical diagnosis.

Pyoderma gangrenosum is frequently associated with an underlying condition such as ulcerative colitis or a myeloproliferative syndrome. However, lymphoproliferative malignancies have only rarely been seen concurrently with pyoderma gangrenosum. We present the case of a patient with small lymphocytic lymphoma who noted a slowly enlarging skin ulcer that was clinically consistent with pyoderma gangrenosum. Examination of a biopsy specimen showed infiltration of the skin with lymphoma cells as well as deeper necrotic material and thrombosis of vessels that were infiltrated by lymphoma. This case illustrates the difficulty of differentiating pyoderma gangrenosum from cutaneous lymphoma clinically.

Diagnosis, Differential↗

PubMed1992

Infantile pyoderma gangrenosum.

A six month old female infant with pyoderma gangrenosum is reported. Pyoderma gangrenosum in an infant is rare. The child responded to pulse therapy with intravenous dexamethasone and intralesional triamcinolone acetonide.

Dexamethasone↗

PubMed1990

Pyoderma gangrenosum in childhood leukemia.

A case of pyoderma gangrenosum (PG) in a 14-year-old boy with acute myelogenous leukemia (AML) is described. The onset of pyoderma gangrenosum coincided with the relapse of AML. The lesions responded dramatically to treatment with oral prednisone despite the persistence of leukemia. Pyoderma gangrenosum should be included in the differential diagnosis of any nodular, pustular, or necrotic cutaneous eruption in children with leukemia.

Adolescent↗

PubMed1998

Pyoderma gangrenosum complicating ulcerative colitis: Successful treatment with methylprednisolone pulse therapy and cyclosporine.

A 32-year-old woman with ulcerative colitis had a relapsed of pyoderma gangrenosum during puerperium. Both the pyoderma gangrenosum and ulcerative colitis had been well controlled with oral prednisolone, but ulcerative colitis relapsed in pregnancy, and pyoderma gangrenosum relapsed in the puerperium. The pyoderma gangrenosum responded to methylprednisolone pulse therapy initially, but relapsed when prednisolone was tapered. A second trial of pulse therapy combined with cyclosporine resulted in complete remission of the pyoderma gangrenosum, and no recurrence was recognized after prednisolone was tapered. This is a very rare case of successful treatment with methylprednisolone pulse therapy combined with cyclosporine for pyoderma gangrenosum complicating ulcerative colitis.

Adult↗

PubMed1994

[Ulcerative colitis associated with pyoderma gangrenosum].

The authors present a 42-year-old man's case in whom the onset of chronic ulcerative colitis and pyoderma gangrenosum was simultaneous. Pyoderma gangrenosum began as bullae on his chest and lower limb. The main symptoms were fever, anaemia, hypoproteinaemia beyond the skin lesions, and the abdominal symptoms characterizing chronic ulcerative colitis were absent. The thorough internal check-up and the micribiologic and histologic examinations of the skin disorders made clear that the lesions mentioned were the skin symptoms of a systemic disease. Sulfasalazin and prednisolone therapy of the underlying disease and the local non-specific treatment of the cutaneous lesions resulted together in the patient's rapid improvement. The authors give a brief review of pyoderma gangrenosum and of the connection between pyoderma gangrenosum and chronic ulcerative colitis.

Adult↗

PubMed2001

[Cutaneous pyoderma gangrenosum with hepatosplenic localization and monoclonal gammapathy. A case report].

Pyoderma gangrenosum is an ulcerative disease of the skin. The histopathological lesions are nonspecific, characterized by a diffuse neutrophilic infiltrate in the dermis. Pyoderma gangrenosum is associated with inflammatory, digestive or articular disease, or acute or chronic hemotology disorders in 50% of the cases, more rarely with monoclonal gammapathy. A visceral localization of pyoderma gangrenosum is rare, simulating a systemic disease or an underlying neoplasia. We report a case of cutaneous pyoderma gangrenosum with splenic and hepatic localizatios associated with an IgG monoclonal gammapathy. We emphasize the efficacy of immunosuppressor treatment and the importance of long-term monitoring of these patients.

Drug Monitoring↗

PubMed1994

Treatment of pyoderma gangrenosum with cultured keratinocyte autografts.

BACKGROUND: Pyoderma gangrenosum is an uncommon chronic skin disease characterized by rapidly enlarging cutaneous ulcers. Immunosuppressive agents, such as corticosteroids, are the mainstay of therapy. OBJECTIVE: We describe a patient with pyoderma gangrenosum treated with cultured keratinocyte autografts for a full-thickness ulcer located on the dorsal and lateral aspects of the foot. METHODS: After stabilizing the ulcer with intralesional and systemic corticosteroids, the ulcer was debrided and cultured keratinocyte autografts were secured with nylon mesh. An outer dressing of gauze and elastic bandage was used. RESULTS: The patient had > 95% "take" of the grafts and the ulcer was fully healed in less than 1 month. The grafted area preserved the clinical phenotype of the palmar skin from which the original biopsy was taken. CONCLUSION: Cultured keratinocyte autografts can provide permanent wound coverage for patients on high doses of immunosuppressive medications.

Administration, Oral↗

PubMed1997

Intravenous cyclosporine therapy in the treatment of pyoderma gangrenosum secondary to Crohn's disease.

Pyoderma gangrenosum is a destructive, ulcerative skin condition often associated with systemic illnesses such as inflammatory bowel disease, myeloproliferative disorders, and the inflammatory arthritides. We present a patient with long-standing pyoderma gangrenosum associated with Crohn's disease. Multiple deep leg ulcerations were unresponsive over the course of several years to treatment with azathioprine, systemic corticosteroids, 6-mercaptopurine, and dapsone. The patient was hospitalized and treated with a ten-day course of intravenous cyclosporine therapy followed by outpatient oral cyclosporine and showed significant improvement.

Adult↗

PubMed1996

Pyoderma gangrenosum severely affecting both hands.

We report a case of pyoderma gangrenosum affecting both hands simultaneously. Pyoderma gangrenosum affecting the hands is an extremely rare condition which may result in considerable tissue destruction. Management includes immunosuppressant therapy, treatment of associated medical conditions and minimal surgical intervention. Despite a high maintenance dose of corticosteroid and adequate control of coexisting ulcerative colitis and rheumatoid arthritis, tissue destruction in the hands spread rapidly in our patient. The key to the patient's dramatic improvement was the tissue biopsy suggesting pyoderma gangrenosum and the subsequent treatment with the cytotoxic immunosuppressant, azathioprine.

Amputation, Surgical↗

PubMed2000

Pyoderma gangrenosum as an early revelator of acute leukemia.

Bullous pyoderma gangrenosum is an atypical, more superficial variety of the classical pyoderma and is often associated with myeloproliferative disorders. We present the case of a patient who presented initially with subcutaneous nodules and who developed bullous lesions afterwards. Histological evaluation showed the presence of neutrophilic infiltrates in both lesions. A few months after the diagnosis of bullous pyoderma gangrenosum, an underlying leukemia was revealed. Our case illustrates the importance of regular blood and bone marrow examinations in patients with atypical bullous pyoderma gangrenosum, resulting in a rapid diagnosis of the underlying disease.

Female↗

PubMed2001

Understanding pyoderma gangrenosum: a review.

CONTEXT: Diagnosis and management of pyoderma gangrenosum, a chronic, ulcerative cutaneous inflammatory disease often associated with systemic disease, requires a multidisciplinary approach. No large-scale, controlled trials have been conducted and, as a consequence, the knowledge of this condition is largely based on anecdotal reports. OBJECTIVE: To investigate current understanding of the diagnosis and management of pyoderma gangrenosum. DESIGN: Critical review article. Two hundred eighty-six articles, limited to articles in English and pertaining to humans, were retrieved and reviewed from a MEDLINE search spanning the years 1960-2000. CONCLUSIONS: Diagnosis of pyoderma gangrenosum often requires consultation by multiple specialists in different fields of medicine. Treatment is individually tailored and depends on disease severity and the presence of associated disease. Local treatment is sufficient for mild disease, and the use of immunosuppressive agents is reserved for severe or refractory cases, with cyclosporin being the agent of choice. The long-term outcome for these patients has not been established.

Humans↗

PubMed1988

Pyoderma gangrenosum as a manifestation of leukemia in childhood.

Pyoderma gangrenosum is an uncommon skin lesion often associated with autoimmune diseases. A clear association between leukemia and pyoderma gangrenosum in adults has been established. Two cases of pyoderma gangrenosum in children with leukemia in whom it may be an initial finding are presented.

Adolescent↗

PubMed2000

Pyoderma gangrenosum occurring in a lower limb fasciocutaneous flap--a lesson to learn.

Pyoderma gangrenosum is a destructive cutaneous disease characterised by progressive painful ulceration. The occurrence of pyoderma gangrenosum at a surgical site is rare (especially if there is no predisposing illness), but is well recognised. We present a case of a 63-year-old man who developed erythematous ulcerative lesions due to pyoderma gangrenosum in and around a lower limb fasciocutaneous flap used to cover an exposed total knee prosthesis. The lesions were initially confused with postoperative wound infection. No predisposing disorder, other than the rarely reported association with osteoarthritis, was found. The diagnosis is important because its rapid detection not only avoids unnecessary treatment but also allows for prompt intervention with oral steroids. This case is presented to alert surgeons to the presence of pyoderma gangrenosum and its diagnostic confusion with postoperative wound infection.

Anti-Inflammatory Agents↗

PubMed1999

Pyoderma gangrenosum with secondary pyarthrosis following propylthiouracil.

The association of pyoderma gangrenosum and arthritic symptoms is well documented. We present a rarely reported variant of this in a 44-year-old woman with pyoderma gangrenosum and bilateral large purulent effusions of her knees. She had no evidence of underlying rheumatoid arthritis or a specific seronegative spondyloarthropathy. Of note she had a history of Graves' disease for which she had been treated with propylthiouracil for 3 years and on investigation at this presentation had a markedly elevated perinuclear antineutrophil cytoplasm antibody (P-ANCA) level with specificities for IgM myeloperoxidase, IgG elastase and IgG lactoferrin. We believe this patient had pyoderma gangrenosum with secondary sterile pyarthrosis and a P-ANCA precipitated by propylthiouracil.

Adult↗

PubMed1987

Pyoderma gangrenosum of the oral cavity, nose, and larynx.

Pyoderma gangrenosum is a clinical condition often associated with internal disorders and immunologic abnormalities. The diagnosis is deduced solely from clinical examination because no histologic or laboratory changes are pathognomonic. The lesions are quite painful and can be particularly disabling. Laryngeal involvement should elicit concerns for protection of the airway. This case demonstrated involvement of the oral cavity, nose, and larynx--as well as other skin sites of the body--with pyoderma gangrenosum. To our knowledge, this is the first reported case of intranasal and laryngeal pyoderma gangrenosum. Early treatment of any associated internal disorders and aggressive treatment with corticosteroids usually result in adequate control of this problem.

Biopsy↗