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Lamberti A, Miracco C, Cinotti E, Trovato E, Vispi M, Fimiani M, Rubegni P. An unusual triple association: Superficial granulomatous pyoderma, subcorneal pustular dermatosis, IgA multiple myeloma. J Cutan Pathol 2020; 48:461-463. [PMID: 33245568 DOI: 10.1111/cup.13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/08/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Arianna Lamberti
- Department of Medical, Surgical and Neurological Science, Section of Dermatology, University of Siena, Siena, Italy
| | - Clelia Miracco
- Department of Human Pathology and Oncology, Pathological Anatomy Section, University of Siena, Siena, Italy
| | - Elisa Cinotti
- Department of Medical, Surgical and Neurological Science, Section of Dermatology, University of Siena, Siena, Italy
| | - Emanuele Trovato
- Department of Medical, Surgical and Neurological Science, Section of Dermatology, University of Siena, Siena, Italy
| | - Martina Vispi
- Department of Medical, Surgical and Neurological Science, Section of Dermatology, University of Siena, Siena, Italy
| | - Michele Fimiani
- Department of Medical, Surgical and Neurological Science, Section of Dermatology, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Science, Section of Dermatology, University of Siena, Siena, Italy
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Li JJ, Beresford R, Fyfe J, Henderson C. Clinical and histopathological features of cutaneous nontuberculous mycobacterial infection: a review of 13 cases. J Cutan Pathol 2017; 44:433-443. [PMID: 28098393 DOI: 10.1111/cup.12903] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The incidence of cutaneous nontuberculous mycobacterial (NTM) infection has increased in recent decades because of widespread use of immunosuppressive therapy and better detection methods. The histopathology of cutaneous NTM infection is not pathognomic and the organisms are slow and difficult to culture, making diagnosis challenging. METHODS We reviewed the clinical and histopathological features of 13 cases of cutaneous NTM infection, and performed panmycobacterial polymerase chain reaction (PCR) on the paraffin blocks. RESULTS The immunocompetent patients presented with localized lesions on the extremities, whereas the immunocompromised patients presented with disseminated cutaneous lesions. The histopathology in immunocompetent patients was characterized by pseudoepitheliomatous epidermal hyperplasia, intraepithelial abscesses, transepidermal elimination and dermal granulomatous inflammation accompanied by necrosis and suppuration. The immunocompromised patients showed suppurative inflammation with little granuloma formation and numerous acid-fast bacilli. Paraffin block PCR was positive in 4 of 13 cases (31%), whereas culture was positive in 11 of 13 cases (85%). CONCLUSION The aforementioned histological features should help in diagnosing cutaneous NTM infection when combined with clinical and microbiological correlation. In our study, we did not find paraffin block PCR to be superior to conventional culture in detecting cutaneous NTM infection.
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Affiliation(s)
- Jing Jing Li
- Department of Anatomical Pathology, Liverpool Hospital, Liverpool, Australia
| | - Rohan Beresford
- Department of Microbiology and Infectious diseases, Liverpool Hospital, Liverpool, Australia
| | - Janet Fyfe
- Mycobacterium Reference Laboratory Victorian Infectious Diseases Reference Laboratory, North Melbourne, Australia
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Yamamoto T. Pyoderma gangrenosum: An important dermatologic condition occasionally associated with rheumatic diseases. World J Rheumatol 2015; 5:101-107. [DOI: 10.5499/wjr.v5.i2.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 04/29/2015] [Indexed: 02/06/2023] Open
Abstract
Pyoderma gangrenosum (PG) presents with refractory, sterile, deep ulcers most often on the lower legs. Clinically, PG exhibits four types, i.e., ulcerative, bullous, pustular, and vegetative types. PG may be triggered by surgical operation or even by minor iatrogenic procedures such as needle prick or catheter insertion, which is well-known as pathergy. PG is sometimes seen in association with several systemic diseases including rheumatoid arthritis (RA), inflammatory bowel disease, hematologic malignancy, and Takayasu’s arteritis. In particular, various cutaneous manifestations are induced in association with RA by virtue of the activation of inflammatory cells (neutrophils, lymphocytes, macrophages), vasculopathy, vasculitis, drugs, and so on. Clinical appearances of ulcerative PG mimic rheumatoid vasculitis or leg ulcers due to impaired circulation in patients with RA. In addition, patients with PG sometimes develop joint manifestations as well. Therefore, it is necessary for not only dermatologists but also rheumatologists to understand PG.
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[Deep-seated granulomatous pyoderma gangrenosum: A novel variant?]. Ann Dermatol Venereol 2015; 142:340-5. [PMID: 25637110 DOI: 10.1016/j.annder.2014.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/23/2014] [Accepted: 11/07/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND We report an extremely rare case of pyoderma gangrenosum with the clinical features of pyoderma gangrenosum but with unusual histopathological findings and deep massive granulomatous infiltration through the dermis. PATIENTS AND METHODS A 15-year-old girl presented with a two-month history of deep ulcers on the lower legs and forehead. She also presented abdominal pain with diarrhea and vomiting that disappeared after symptomatic treatment. Histology showed extensive granulomatous infiltration in the dermis and hypodermis and a micro-abscess in the dermis. An abdominopelvic CT scan revealed peritoneal fluid and tissue formation in a lateral carotid cave (6.56 cm/4.56 cm). Colonoscopy was normal. The patient was treated with oral prednisone, resulting in resolution of the problems of cutaneous lesions, peritoneal fluid and tissue formation. DISCUSSION Our case involves a rare presentation of pyoderma gangrenosum (PG) inconsistent with any of the four clinical variants of PG and characterized histologically by the presence of deep granulomas in the dermis and hypodermis. Despite the atypical clinical presentation and unusual histopathological findings, PG seemed the most likely diagnosis after infectious diseases had been ruled out; the good outcome achieved with oral corticosteroids supported our diagnosis.
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Kambil SM, Bhat RM, Dandekeri S. Granulomatous pyoderma gangrenosum of the genitalia in the absence of Crohn's disease. Indian J Sex Transm Dis AIDS 2015; 36:67-9. [PMID: 26392658 DOI: 10.4103/0253-7184.156732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a rare ulcerative neutrophilic disorder of the skin. Atypical variants of PG such as vegetative PG, bullous PG, and pustular forms are described in literature. Occasionally, granulomatous reaction in dermis may be seen on histology when PG is associated with Crohn's disease or in the vegetative variant of PG. We report a case of granulomatous PG involving the genitalia in a 43-year-old female without associated inflammatory bowel disease.
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Affiliation(s)
- Srinath M Kambil
- Department of Dermatology, Father Muller Medical College, Kankanady, Mangalore, Karnataka, India
| | - Ramesh M Bhat
- Department of Dermatology, Father Muller Medical College, Kankanady, Mangalore, Karnataka, India
| | - Sukumar Dandekeri
- Department of Dermatology, Father Muller Medical College, Kankanady, Mangalore, Karnataka, India
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D'Epiro S, Salvi M, Mattozzi C, Giancristoforo S, Faina V, Macaluso L, Luci C, Grieco T, Calvieri S, Richetta AG. Facial superficial granulomatous pyoderma. Int Wound J 2013; 12:737-8. [PMID: 24283375 DOI: 10.1111/iwj.12195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 11/04/2013] [Indexed: 02/02/2023] Open
Affiliation(s)
- Sara D'Epiro
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Monica Salvi
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Carlo Mattozzi
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Simona Giancristoforo
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Valentina Faina
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Laura Macaluso
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Cecilia Luci
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Teresa Grieco
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Stefano Calvieri
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Antonio G Richetta
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
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Cardoso JC, Calonje E. Cutaneous infections presenting with granulomatous infiltrates: a review of histopathological patterns. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.mpdhp.2013.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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TAO W, TAO Q, YUE-HUA L. Superficial granulomatous pyoderma accompanied with ulcerative colitis successfully treated with tacrolimus ointment. J Dermatol 2011; 38:1105-1108. [DOI: 10.1111/j.1346-8138.2011.01212.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tollefson MM, Cook-Norris RH, Theos A, Davis DMR. Superficial granulomatous pyoderma: a case in an 11-year-old girl and review of the literature. Pediatr Dermatol 2010; 27:496-9. [PMID: 21182640 DOI: 10.1111/j.1525-1470.2010.01271.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Superficial granulomatous pyoderma is a rare entity thought to be a variant of pyoderma gangrenosum and is often mistaken for classic pyoderma gangrenosum. Superficial granulomatous pyoderma has mainly been described in adults. We describe a case of Superficial granulomatous pyoderma in an 11-year-old girl and present a review of the literature. Superficial granulomatous pyoderma maintains clinical and histopathologic characteristics distinct from classic pyoderma gangrenosum and has a more favorable prognosis. It is often responsive to conservative treatment.
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Affiliation(s)
- Megha M Tollefson
- Division of Clinical Dermatology, Mayo Clinic, Rochester, MN 55905, USA
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Berbert ALCV, Mantese SADO, Rocha A, Rezende J, Cunha TFR. Pioderma granulomatoso superficial: relato de caso de variante rara do pioderma gangrenoso. An Bras Dermatol 2009; 84:285-8. [DOI: 10.1590/s0365-05962009000300012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O pioderma gangrenoso é doença cutânea inflamatória rara, idiopática. Afeta principalmente adultos; apenas cerca de 4% dos casos são diagnosticados em crianças e adolescentes. Existem quatro formas clínicas de pioderma gangrenoso: ulcerativa, pustular, bolhosa e vegetante (pioderma granulomatoso superficial). O pioderma granulomatoso superficial é considerado a forma mais benigna e incomum da doença. Em pacientes submetidos a manipulação cirúrgica, uma eventual manifestação do pioderma gangrenoso ocorre nos locais de intervenção. Relata-se o caso de criança de cinco anos de idade, vítima de queimadura, que apresentou pioderma granulomatoso superficial sobre áreas doadoras de enxertos.
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CA55 - Pyoderma granulomateux superficiel : forme rare et trompeuse du pyoderma gangrenosum. Ann Dermatol Venereol 2007. [DOI: 10.1016/s0151-9638(07)89153-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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García VS, Trelles AS. Superficial granulomatous pyoderma: successful treatment with minocycline. J Eur Acad Dermatol Venereol 2006; 20:1134-5. [PMID: 16987273 DOI: 10.1111/j.1468-3083.2006.01625.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Sinead M Langan
- Regional Center of Dermatology, Mater Misericordiae Hospital, Dublin, Ireland
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Abstract
INTRODUCTION Superficial granulomatous pyoderma is a rare variant of pyoderma gangrenosum, which is often diagnosed at a late stage because of misleading clinical-histopathological features. We report a new case of this rare disease. CASE REPORT A 67 year-old man presented with inflammatory lesions that had become ulcerated over the past 4 months despite prolonged antibiotic therapy. The histopathological aspect was initially suggestive of palisading granuloma annulare and subsequently a necrotizing granuloma compatible with a mycobacteriosis. The various supplementary examinations eliminated the possibility of an infectious or systemic disease. The lesions became painful and ulcerated. A second biopsy showed a neutrophilic dermatosis with dermal necrosis and a granuloma leading to the diagnosis of superficial granulomatous pyoderma. The lesions healed after 3 months of systemic corticosteroids at the dose of 1 mg/kg/day. DISCUSSION The clinical features of superficial granulomatous pyoderma are similar to those of classical pyoderma gangrenosum. However, its histological profile is more superficial and is associated with dermal granulomas. The latter are unusual in neutrophilic dermatosis and would suggest an infectious disease. This explains the frequent diagnostic errors, with inappropriate anti-infectious treatments and notably unnecessary surgical exeresis.
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Affiliation(s)
- M Mitcov Milea
- Clinique Dermatologique, Hôpitaux Universitaires, 1 place de l'Hôpital, 67091 Strasbourg, France
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Kaneko T, Tamai K, Yamazaki T, Harada K, Nakano H, Hanada K. Superficial granulomatous pyoderma: a case report of two Japanese patients and clinical comparison with foreign patients. J Dermatol 2003; 30:472-6. [PMID: 12810995 DOI: 10.1111/j.1346-8138.2003.tb00418.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2003] [Accepted: 03/18/2003] [Indexed: 11/30/2022]
Abstract
Superficial granulomatous pyoderma (SGP) is an unusual variant type of pyoderma gangrenosum characterized by a benign course and specific histological features; it is quite a rare cutaneous disorder in Japan. We reported two Japanese cases of SGP and compared the clinical features of 13 Japanese cases with those of 42 foreign cases. Case 1 was a 53-year-old female who presented with three indolent and ulcerative plaques with elevated edges on the back and the posterior portion of the left thigh. Case 2 was a 74-year-old female who presented with crusted and vegetative erythematous plaques on the left shoulder and left upper arm. Histological examinations revealed a characteristic three-layer granuloma in each case. Laboratory and physical examinations found no abnormalities. Topical corticosteroid, oral administration of minocycline, and/or additional supplementation with corticosteroid were effective. In comparison with foreign cases, Japanese cases show a possible differentiation in the ratio of sex and distribution of the ulcer. Females have a high incidence and the extremities are frequently involved area in Japanese cases. Up to now, 11 cases of SGP have been reported in Japan. To our best knowledge, our patients are the first Japanese cases described in the English literature.
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Affiliation(s)
- Takahide Kaneko
- Department of Dermatology, Hirosaki University School of Medicine, Hirosaki 036-8562, Japan
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