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Crouse L, McShane D, Morrell DS, Wu EY. Pyoderma gangrenosum in an infant: A case report and review of the literature. Pediatr Dermatol 2018; 35:e257-e261. [PMID: 29656404 DOI: 10.1111/pde.13471] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pyoderma gangrenosum is a neutrophilic dermatosis that is rare in infancy, with only 20 cases reported in the literature. We present a case of infantile pyoderma gangrenosum refractory to topical steroids, tacrolimus, and dapsone as well as systemic steroids and infliximab that is currently well controlled with the addition of oral tacrolimus. To our knowledge, this is the first report of the effective, safe use of oral tacrolimus in combination with infliximab for infantile pyoderma gangrenosum. We review all current cases of infantile pyoderma gangrenosum, as well as tacrolimus and its role in the treatment of this condition.
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Affiliation(s)
- Lauren Crouse
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diana McShane
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dean S Morrell
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eveline Y Wu
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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2
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Papadopoulos AJ, Schwartz RA, Kapila R, Samady JA, Ruszczak Z, Rao BK, Lambert WC. Pyoderma Vegetans. J Cutan Med Surg 2016. [DOI: 10.1177/120347540100500306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Pyoderma vegetans is a rare condition that is clinically characterized by large verrucous plaques with elevated borders and multiple pustules. The etiology of this disorder remains unknown. Objectives: We describe a 24-year-old woman with rapidly evolving pyoderma vegetans. Our patient had the unique additional findings of a highly elevated serum IgE level and a history of hidradenitis suppurativa. Conclusions: Pyoderma vegetans is diagnosed on clinical and histological criteria. Differentiation must be made from disorders such as pyoderma gangrenosum, Sweet's syndrome, and deep fungal infections. We illustrate a case of pyoderma vegetans and review the literature on this rare disorder. Clinical and histological criteria for diagnosis are presented, as well as differentiation from some mimicking disorders.
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Affiliation(s)
| | - Robert A. Schwartz
- Dermatology, New Jersey Medical School, Newark, New Jersey
- Pathology, New Jersey Medical School, Newark, New Jersey
| | - Rajendra Kapila
- Infectious Diseases, New Jersey Medical School, Newark, New Jersey
| | | | | | | | - W. Clark Lambert
- Dermatology, New Jersey Medical School, Newark, New Jersey
- Pathology, New Jersey Medical School, Newark, New Jersey
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3
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DeFilippis E, Feldman S, Huang W. The genetics of pyoderma gangrenosum and implications for treatment: a systematic review. Br J Dermatol 2015; 172:1487-1497. [DOI: 10.1111/bjd.13493] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 12/22/2022]
Affiliation(s)
- E.M. DeFilippis
- Center for Dermatology Research; Department of Dermatology; Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem NC 27157 U.S.A
| | - S.R. Feldman
- Center for Dermatology Research; Department of Dermatology; Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem NC 27157 U.S.A
- Department of Pathology; Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem NC 27157 U.S.A
- Department of Public Health Sciences; Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem NC 27157 U.S.A
| | - W.W. Huang
- Center for Dermatology Research; Department of Dermatology; Wake Forest School of Medicine, Medical Center Boulevard; Winston-Salem NC 27157 U.S.A
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4
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Prat L, Bouaziz JD, Wallach D, Vignon-Pennamen MD, Bagot M. Neutrophilic dermatoses as systemic diseases. Clin Dermatol 2013; 32:376-88. [PMID: 24767185 DOI: 10.1016/j.clindermatol.2013.11.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neutrophilic dermatoses (ND) are inflammatory skin conditions characterized by a sterile infiltrate of normal polymorphonuclear leukocytes. The main clinical forms of ND include Sweet syndrome, pyoderma gangrenosum, erythema elevatum diutinum, subcorneal pustular dermatosis, and their atypical or transitional forms. ND are often idiopathic, but they may be associated with myeloid hematologic malignancies (Sweet syndrome), inflammatory bowel disease or rheumatoid arthritis (pyoderma gangrenosum), and monoclonal gammopathies (erythema elevatum diutinum, subcorneal pustular dermatosis). The possible infiltration of internal organs with neutrophils during the setting of ND underlies the concept of a neutrophilic systemic disease. ND may be seen as a polygenic autoinflammatory syndrome due to their frequent association with other autoinflammatory disorders (monogenic or polygenic) and the recent published efficacy of interleukin-1 blocking therapies in their management.
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Affiliation(s)
- Lola Prat
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Jean-David Bouaziz
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France.
| | - Daniel Wallach
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Marie-Dominique Vignon-Pennamen
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Martine Bagot
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
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5
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Pyoderma gangrenosum: an exceptional complication of venous access device. J Vasc Access 2013; 15:321-4. [PMID: 24190068 DOI: 10.5301/jva.5000181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Pyoderma gangrenosum (PG) is a rare disease whose precise etiology remains unknown. It causes rapidly developing skin necrosis and can occur after surgery, or after a nonspecific external stimulus. This condition is difficult to diagnose because it often mimics a fulminant infection. CLINICAL CASE We present a case of very significant local presentation of PG after placement of a venous access device. Fifteen days after placement, the patient developed extensive cutaneous ulcers and necrosis in the subclavicular area, which led to the misdiagnosis of infection. The device was removed and the patient was given antibiotics. Because there was no improvement following antibiotic treatment, combined with the worrying and extensive appearance of the skin and extremely intense pain, the diagnosis of PG was made. The patient was immediately treated with high-dose corticosteroids, resulting in rapid improvement of the lesions and relief of pain. CONCLUSION PG should be considered in cases of extensive, antibiotic-resistant ulceration and treatment with corticosteroids should be initiated. Clinical improvement is usually dramatic, with almost immediate suppression of the pain and arrest of the lesion's progression. Early treatment is the best guarantee for an effective recovery.
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6
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Ahronowitz I, Harp J, Shinkai K. Etiology and management of pyoderma gangrenosum: a comprehensive review. Am J Clin Dermatol 2012; 13:191-211. [PMID: 22356259 DOI: 10.2165/11595240-000000000-00000] [Citation(s) in RCA: 265] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by painful, necrotic ulceration. It typically affects patients in the third to sixth decades of life, with almost equal incidence in men and women. PG occurs most frequently on the lower extremities. Five clinical variants are currently recognized: classic, bullous, pustular, vegetative, and peristomal types. Half of PG cases are seen in association with systemic disease. Mimickers include infection, vascular insufficiency ulcers, systemic vasculitides, autoimmune disease, cancer, and exogenous tissue injury, among others. PG is often a diagnosis of exclusion, as there are no specific laboratory or histopathologic findings to confirm the diagnosis. PG thus presents many clinical challenges: it is difficult to diagnose, is frequently misdiagnosed, and often requires a work-up for underlying systemic disease. Successful management of PG typically requires multiple modalities to reduce inflammation and optimize wound healing, in addition to treatment of any underlying diseases. Prednisone and cyclosporine have been mainstays of systemic treatment for PG, although increasing evidence supports the use of biologic therapies, such as tumor necrosis factor-α inhibitors, for refractory cases of PG. Here, we review the clinical presentation and pathophysiology of PG, as well as its associated conditions, diagnostic work-up, and management.
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Affiliation(s)
- Iris Ahronowitz
- Department of Dermatology, University of California, San Francisco, 94115, USA
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7
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Affiliation(s)
- A A Karim
- Queens Park Hospital, Blackburn, UK.
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8
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Le pyoderma gangrenosum : pathologie rare ou diagnostic omis ? ANN CHIR PLAST ESTH 2009; 54:82-7. [DOI: 10.1016/j.anplas.2008.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 05/15/2008] [Indexed: 11/17/2022]
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9
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Newell EL, Chaudhry SI, Black MM. Acute bullous hemorrhagic pyoderma gangrenosum: pitfalls of diagnostic delay. A case report. J Bone Joint Surg Am 2008; 90:174-7. [PMID: 18171972 DOI: 10.2106/jbjs.f.00918] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- E L Newell
- St. John's Institute of Dermatology, St. Thomas' Hospital, London, United Kingdom.
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10
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Sayah A, English JC. Rheumatoid arthritis: a review of the cutaneous manifestations. J Am Acad Dermatol 2006; 53:191-209; quiz 210-2. [PMID: 16021111 DOI: 10.1016/j.jaad.2004.07.023] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Rheumatoid arthritis is a chronic inflammatory arthritis with significant extra-articular manifestations. Of note are unique cutaneous manifestations that the dermatologist may encounter. This article will make the dermatologist more cognizant of these skin findings in patients with this systemic inflammatory disorder. It examines rheumatoid arthritis, focusing on the general nonspecific and disease-specific rheumatoid arthritic skin changes. Classic rheumatoid nodules, accelerated rheumatoid nodulosis, rheumatoid nodulosis, rheumatoid vasculitis, Felty syndrome, pyoderma gangrenosum, interstitial granulomatosus dermatitis with arthritis, palisaded neutrophilic and granulomatosis dermatitis, rheumatoid neutrophilic dermatitis, juvenile rheumatoid arthritis, and adult-onset Still disease are reviewed. Understanding the cutaneous expressions of rheumatoid arthritis may lead to early diagnosis, prompt treatment, and lower morbidity and mortality for the affected persons. Learning objective At the completion of this learning activity, participants should be able to describe rheumatoid arthritis in terms of its epidemiology, etiology, pathogenesis, and general and specific cutaneous manifestations.
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Affiliation(s)
- Anousheh Sayah
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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11
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Su WPD, Davis MDP, Weenig RH, Powell FC, Perry HO. Pyoderma gangrenosum: clinicopathologic correlation and proposed diagnostic criteria. Int J Dermatol 2005; 43:790-800. [PMID: 15533059 DOI: 10.1111/j.1365-4632.2004.02128.x] [Citation(s) in RCA: 338] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pyoderma gangrenosum is a rare but significant cause of ulcerations. It is a diagnosis of exclusion. Herein, we suggest diagnostic criteria and some historical perspectives on the diagnosis of pyoderma gangrenosum.
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Affiliation(s)
- W P Daniel Su
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
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12
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Abstract
A 74-year-old woman presented with an antineutrophil cytoplasmic antibody titre-negative, treatment-responsive Wegener's granulomatosis confined to the integument. She initially presented with a painful left postauricular nodulo-ulcerative lesion with chronically discharging sinuses. This lesion was effectively treated with a short, 3-month course of cyclophosphamide and 24 months of oral prednisone. After 5 months in remission, she developed further similar ulcers, in addition to painless nodules on her ankles and feet bilaterally. These lesions resolved with an extra 32 months of high-dose oral prednisone therapy before complete remission. At most recent review, there was no evidence of disease recurrence 21 months after ceasing all active treatment. Histology demonstrated a granulomatous inflammation. No systemic disease progression to the upper respiratory tract, lung or kidney was detected. This case highlights the importance of being aware of atypical or partial presentations of Wegener's granulomatosis. This diagnosis needs to be considered with patients presenting with a culture-negative chronic ulcer, where malignancy and trauma have been excluded. This will avoid unnecessary surgery and ensure early diagnosis and effective treatment of a disease that is disfiguring and usually fatal if inappropriately treated.
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Affiliation(s)
- Johanna Kuchel
- The University of Sydney, Department of Dermatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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14
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Abstract
Lower extremity ulcers can be challenging diagnostically and therapeutically. This article, provides an overview of the different kinds of lower extremity wounds typically seen by the medical dermatologist. It also reviews new treatment modalities, including topical growth factors and bioengineered skin. A team approach is emphasized.
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Affiliation(s)
- M M Choucair
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
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15
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Goreti Catorze M, Pereira F, Fonseca F, Morbey A, Assis Pacheco F. Pyoderma gangrenosum associated with sclerosing cholangitis, type 1 diabetes mellitus and ulcerative colitis. J Eur Acad Dermatol Venereol 2001; 15:257-9. [PMID: 11683294 DOI: 10.1046/j.1468-3083.2001.00260.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We describe the case of a 22-year-old black female with type 1 diabetes mellitus diagnosed when she was 12 years old. She first presented (March 1994) with pustules and ulcerations on the upper and lower limbs, trunk and scalp at the age 17. The diagnosis of pyoderma gangrenosum was made. Since presentation, changes in liver function were detected and subsequent study led to the diagnosis of sclerosing cholangitis. The diagnosis of ulcerative colitis was made after colonoscopy. Partial response was obtained with minocycline and clofazimine, but treatment with 5-aminosalicylic acid achieved no improvement of the ulcerations. Liver transplantation, followed by immunosuppressive therapy led to complete regression of the cutaneous lesions.
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Affiliation(s)
- M Goreti Catorze
- Department of Dermatology, Hospital de Curry Cabral, Lisbon, Portugal
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16
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Piodermia gangrenosa asociada a gammapatía monoclonal IgA de significado incierto. ACTAS DERMO-SIFILIOGRAFICAS 2001. [DOI: 10.1016/s0001-7310(01)76475-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Jain A, Nanchahal J, Bunker C. Pyoderma gangrenosum occurring in a lower limb fasciocutaneous flap--a lesson to learn. BRITISH JOURNAL OF PLASTIC SURGERY 2000; 53:437-40. [PMID: 10876286 DOI: 10.1054/bjps.2000.3351] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- A Jain
- Departments of Plastic and Reconstructive Surgery, Dermatology, Imperial College School of Medicine, Charing Cross Hospital Campus, London, UK
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18
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De Silva B, Doherty VR. Coexistence of pyoderma gangrenosum and Cushing's disease: a paradoxical association? Br J Dermatol 2000; 142:1051-2. [PMID: 10809875 DOI: 10.1046/j.1365-2133.2000.03499.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Affiliation(s)
- D E Manthey
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX 78234-6200, USA.
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20
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Daoud MS, Lust JA, Kyle RA, Pittelkow MR. Monoclonal gammopathies and associated skin disorders. J Am Acad Dermatol 1999; 40:507-35; quiz 536-8. [PMID: 10188670 DOI: 10.1016/s0190-9622(99)70434-2] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The monoclonal gammopathies are characterized by clonal proliferation of plasma cells and other clonally related cells in the B-cell lineage. These disorders include monoclonal gammopathy of undetermined significance, multiple myeloma, Waldenström macroglobulinemia, heavy chain diseases, plasmacytoma, and primary amyloidosis. Many skin disorders have been described in association with monoclonal gammopathies. This article provides an introduction to the definition, detection, natural course, and spectrum of monoclonal gammopathies and a brief discussion of pathogenesis. The article also reviews the skin disorders associated with monoclonal gammopathies, categorizes the association, and evaluates the strength of the association.
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Affiliation(s)
- M S Daoud
- Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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21
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Wilson DM, John GR, Callen JP. Peripheral ulcerative keratitis--an extracutaneous neutrophilic disorder: report of a patient with rheumatoid arthritis, pustular vasculitis, pyoderma gangrenosum, and Sweet's syndrome with an excellent response to cyclosporine therapy. J Am Acad Dermatol 1999; 40:331-4. [PMID: 10025862 DOI: 10.1016/s0190-9622(99)70479-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The term peripheral ulcerative keratitis represents a spectrum of inflammatory diseases, characterized by cellular infiltration, corneal thinning, and ulceration. Neutrophilic dermatoses are rarely associated with peripheral ulcerative keratitis. To date, peripheral ulcerative keratitis has only been reported in patients with pyoderma gangrenosum. Separate episodes of pyoderma gangrenosum, Sweet's syndrome, and pustular vasculitis developed in a 60-year-old patient with rheumatoid arthritis over an 8-year period. Over the past 2 years, 3 episodes of peripheral ulcerative keratitis occurred. Cyclosporine (4 mg/kg/d) treatment was started on confirmation of pyoderma gangrenosum. Over the ensuing 2 years, it became evident that the activity of her ocular and skin diseases, as well as her arthritis, paralleled the administration or cessation of cyclosporine therapy. Dermatologists should be aware of the association of Sweet's syndrome, pyoderma gangrenosum, and pustular vasculitis with peripheral ulcerative keratitis. This rare ocular manifestation and the serious sequelae when left untreated make recognition crucial. Cyclosporine proved to be a very effective treatment for all of our patient's diseases.
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Affiliation(s)
- D M Wilson
- Department of Medicine, University of Louisville School of Medicine, Kentucky, USA
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22
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Abstract
Pyoderma gangrenosum affecting the nose is rare and this may lead to diagnostic confusion because of the large differential diagnosis. As diagnosis is made, largely, on the basis of exclusion the treatment of pyoderma gangrenosum may be unduly delayed. The condition is often disfiguring, particularly following inappropriate surgical intervention, and early diagnosis is therefore important. We present a case of pyoderma gangrenosum managed initially in the community with minor surgery and resulting in the rare complication of saddle nose deformity.
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Affiliation(s)
- G A Worley
- Department of Otolaryngology, Head and Neck Surgery, Kent and Sussex Weald NHS Trust, Kent and Sussex Hospital, Tunbridge Wells, UK
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Kasuga I, Yanagisawa N, Takeo C, Koga M, Kiyokawa H, Yonemaru M, Ichinose Y, Toyama K. Multiple pulmonary nodules in association with pyoderma gangrenosum. Respir Med 1997; 91:493-5. [PMID: 9338053 DOI: 10.1016/s0954-6111(97)90115-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This report describes a patient with extensive pyoderma gangrenosum in whom there were co-existent lung abnormalities. The patient's X-ray showed peripherally sited multiple pulmonary lesions bilaterally. A lung biopsy showed chronic non-specific inflammatory changes with neutrophil and lymphocyte infiltration which were similar to the skin lesions. This case was diagnosed as multiple aseptic nodules in pyoderma gangrenosum. The pulmonary infiltrative shadows were controlled only with prednisolone treatment. Steroid therapy is considered to be the first choice to control pulmonary lesions of this disease.
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Affiliation(s)
- I Kasuga
- First Department of Internal Medicine, Tokyo Medical College, Japan
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25
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Adam DJ, Nawroz I, Petrie PW. Pyoderma gangrenosum severely affecting both hands. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1996; 21:792-4. [PMID: 8982930 DOI: 10.1016/s0266-7681(96)80193-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- D J Adam
- Department of Orthopaedic Surgery, Queen Margaret Hospital Dunfermline, UK
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26
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Abstract
Critical to the proper management of pyoderma gangrenosum are correct diagnosis, identification and treatment of any underlying disorder, and the proper choice of topical and systemic therapy. Many agents are available for the treatment of pyoderma gangrenosum. We review the current therapeutic options, their efficacy and side effects, and we offer some guidelines for their proper selection.
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Affiliation(s)
- R K Chow
- Department of Medicine, University of British Columbia, Vancouver, Canada
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27
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Abstract
Pyoderma gangrenosum (PG) has four distinctive clinical and histologic variants. Some have morphologic and histologic overlapping features with other reactive neutrophilic skin conditions. PG often occurs in association with a systemic disease, and the specific clinical features of the skin lesion may provide a clue to the associated disease. Management of PG depends on its type and severity and usually requires aggressive local and systemic treatment.
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Affiliation(s)
- F C Powell
- Regional Centre of Dermatology, Mater Misericordiae, Dublin, Ireland
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28
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Affiliation(s)
- R Gallo
- Department of Dermatology, University of Genoa, Italy
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29
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Abstract
Pyoderma gangrenosum has previously been reported in four patients with HIV infection. We describe here the case of a fifth HIV-infected patient with pyoderma gangrenosum and review the characteristics of the four previously reported cases.
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Affiliation(s)
- H H Clark
- Department of Dermatology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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30
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Merli GJ, Robinson L, Spandorfer J, Paluzzi R. Diagnosis and assessment of leg ulcers. Clin Dermatol 1994; 12:11-7. [PMID: 8180933 DOI: 10.1016/0738-081x(94)90252-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- G J Merli
- Division of Internal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania 19107
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31
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Richardson JB, Callen JP. Pyoderma gangrenosum treated successfully with potassium iodide. J Am Acad Dermatol 1993; 28:1005-7. [PMID: 8496442 DOI: 10.1016/s0190-9622(08)80654-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
Pyoderma Gangrenosum (PG) is often associated with an underlying disease. PG as a paraneoplastic disease is illustrated by the presentation of four patients with malignancy of myeloproliferative origin and PG. An associated malignancy is found in approximately 7% of patients with PG, most commonly haematologic in nature and in particular leukaemia. Clinically the PG is often of the superficial bullous variant and is associated with a poor prognosis.
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Affiliation(s)
- C M Duguid
- Department of Dermatology, Mater Misericordiae Hospital, Dublin, Ireland
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Hostetler LW, von Feldt J, Werth VP. Cutaneous ulcers in a patient with systemic lupus erythematosus. ARTHRITIS AND RHEUMATISM 1993; 36:91-3. [PMID: 8424843 DOI: 10.1002/art.1780360116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- L W Hostetler
- Department of Dermatology, University of Pennsylvania, Philadelphia 19104
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34
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Abstract
We report a 69-year-old caucasian male patient with long-standing pyoderma gangrenosum; the lesions preceded the appearance of an IgA monoclonal gammopathy by 2 years. A number of systemic treatments, including high dose steroids and immunosuppressive agents, were poorly tolerated and resulted in serious side-effects. The skin and haematological conditions, however, were kept under control for 2 years with regular plasmapheresis. Pyoderma gangrenosum recurred as vascular access became exhausted but new lesions healed completely with topical application of 20% nitrogen mustard.
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Affiliation(s)
- E Tsele
- Unit of Dermatology, Hammersmith Hospital, Royal Postgraduate Medical School, London, UK
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35
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Ho KK, Otridge BW, Vandenberg E, Powell FC. Pyoderma gangrenosum, polycythemia rubra vera, and the development of leukemia. J Am Acad Dermatol 1992; 27:804-8. [PMID: 1469131 DOI: 10.1016/0190-9622(92)70252-b] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A patient with long-standing, well-controlled polycythemia rubra vera developed recurrent episodes of bullous pyoderma gangrenosum followed by the transformation of his hematologic disease into a rapidly progressive acute myeloid leukemia. This case, together with previously described patients, indicates that the appearance of bullous pyoderma gangrenosum in a patient with polycythemia rubra vera is often of ominous prognostic significance.
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Affiliation(s)
- K K Ho
- Regional Centre of Dermatology, Mater Misericordiae Hospital, Dublin, Ireland
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36
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Abstract
Fourteen cases of pyoderma gangrenosum were seen over a period of 24 years at the Hull Royal Infirmary Dermatology Department. Several associated conditions were found. Seven cases were associated with rheumatoid arthritis of which five were sero-positive, including one with Felty's syndrome. One case was associated with both ulcerative colitis and psoriasis; one with polycythemia rubra vera; two patients had diverticular disease including one who also had rheumatoid arthritis; one had positive syphilis serology. In three cases there was no significant associated disease identified. Ten out of the fourteen cases were women, indicating a female preponderance by a ratio of about 2F:1M; a figure similar to that stated by Seitzinger. The age of presentation ranged from 30 to 80 years.
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Affiliation(s)
- C B Ko
- Department of Dermatology, Hull Royal Infirmary, Leeds, United Kingdom
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37
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Abstract
We report a case of pyoderma gangrenosum in a 80-year-old woman suffering from ulcerative colitis and treated with clofazimine. Significant improvement was evident within 5 days following commencement of therapy, complete healing occurred after only 4 weeks of treatment.
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Affiliation(s)
- B Kaplan
- Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, Israel
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38
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Affiliation(s)
- K S Babe
- Department of Veterans Affairs, Medical Center, Nashville, Tennessee
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39
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Abstract
The management of pyoderma gangrenosum often requires systemic drug therapy, such as corticosteroids, sulfones, or immunosuppressants, either alone or in combination. Inconsistent response to therapy is a source of frustration to both patient and physician. Several reports in the literature document the successful treatment of pyoderma gangrenosum with hyperbaric oxygen therapy. In our patient, a woman with severe rheumatoid arthritis and diabetes mellitus, hyperbaric oxygen therapy not only promoted healing of pyoderma gangrenosum but permitted reduction of systemic corticosteroids.
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Affiliation(s)
- V Wasserteil
- Department of Dermatology, Baylor College of Medicine, Houston, Texas 77030
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40
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Abstract
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.
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Affiliation(s)
- J Sood
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
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41
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Kavanagh GM, Ross JS, Cronin E, Smith NP, Black MM. Recalcitrant pyoderma gangrenosum--two cases successfully treated with cyclosporin A. Clin Exp Dermatol 1992; 17:49-52. [PMID: 1424262 DOI: 10.1111/j.1365-2230.1992.tb02535.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The successful use of cyclosporin A (CSA) in organ transplantation is now well established. In recent years its usefulness has extended to the treatment of cutaneous autoimmune disorders, including pyoderma gangrenosum (P.G.). We report two further cases of recalcitrant P.G., both associated with rheumatoid arthritis (R.A.) which responded to low dose CSA.
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Affiliation(s)
- G M Kavanagh
- St Johns Dermatology Centre, St Thomas' Hospital, London, UK
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42
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Abstract
Two patients with recalcitrant pyoderma gangrenosum were treated with oral cyclosporin A (5 mg/kg body-weight/day). Healing of the lesions was achieved in Patient 1 within 1 month of starting treatment, but new areas of ulceration appeared when the dose was reduced to 3 mg/kg body-weight/day. The ulcers showed marked improvement by 3 weeks after the start of treatment in Patient 2 and remained inactive at a maintenance dosage of 100 mg/day, but there was no change in the associated seronegative arthritis. A steroid-sparing effect of CyA was evident in both patients. It is suggested that a lower dose of cyclosporin A than doses used previously in the treatment of pyoderma gangrenosum may be equally effective.
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Affiliation(s)
- C Soria
- Department of Dermatology, Hospital Ramón y Cajal, Madrid, Spain
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43
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Kitahama A, Roland PY, Kerstein MD. Pyoderma gangrenosum with cutaneous T-cell lymphoma manifested as lower extremity ulcers--case reports. Angiology 1991; 42:498-503. [PMID: 2042799 DOI: 10.1177/000331979104200610] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patients with extensive lower extremity ulcerations initially thought to be vascular disease were subsequently proved to have pyoderma gangrenosum and malignant lymphoma. Both patients died of sepsis; one patient exhibited hypogammaglobulinemia involving immunoglobulins IgA, IgG, and IgE; in the second patient, a polyclonal excess involving IgA and IgE was present.
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Affiliation(s)
- A Kitahama
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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44
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Abstract
Pyoderma gangrenosum is an idiopathic dermatologic disease manifested by painful cutaneous ulceration. The ulcers are characterized by their undermined, violaceous borders and necrotic tissue at the ulcer base. The lesions may have an unusual response to physical manipulation known as pathergy, a phenomenon that is manifested by rapid progression following debridement. Pyoderma gangrenosum is frequently associated with systemic diseases such as inflammatory bowel disease, rheumatoid arthritis, chronic active hepatitis and hematologic malignancies. Conservative wound care and systemic corticosteroids are usually effective therapy. We report the second case in the gynecologic literature of a patient with vulvar pyoderma gangrenosum.
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Affiliation(s)
- C S McCalmont
- Department of Dermatology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27103
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45
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Pinto GM, Cabeças MA, Riscado M, Gonçalves H. Pyoderma gangrenosum associated with systemic lupus erythematosus: response to pulse steroid therapy. J Am Acad Dermatol 1991; 24:818-21. [PMID: 2050846 DOI: 10.1016/0190-9622(91)70122-i] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pyoderma gangrenosum in a 35-year-old woman with long-standing systemic lupus erythematosus was treated with pulse steroid therapy. Significant improvement in the ulceration and control of the lupus erythematosus occurred. The unusual association of these disorders is reviewed, and the efficacy of pulse therapy in the treatment of refractory cases of pyoderma gangrenosum is discussed.
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Affiliation(s)
- G M Pinto
- Department of Dermatology, Curry Cabral Hospital, Lisbon, Portugal
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46
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O'Keane JC, Martin AW, Wilgram GF. Pyoderma gangrenosum coexistent with the hemophagocytic syndrome. J Am Acad Dermatol 1991; 24:782-4. [PMID: 1869654 DOI: 10.1016/s0190-9622(08)80368-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J C O'Keane
- Department of Pathology, Boston University School of Medicine, MA
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47
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Abstract
Five patients (four black Nigerian males and one Polynesian) with pyoderma gangrenosum (PG) were seen between May 1974 and March 1984, at the Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria. Their age range was 12-42 years (mean 25.6 years). The female expatriate Polynesian patient had PG localized to the upper back while the other four patients had severe and extensive PG lesions. Local cleansing and dressing of the ulcers combined with appropriate systemic antibiotics produced healing in two of these patients. The empirical addition of dapsone and rifampicin led to complete healing in two others, but only transient remission in one patient who, after 22 years of disease activity, died at home from an aggressive and accelerated form of the disease best described as 'malignant pyoderma' gangrenosum.
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Affiliation(s)
- O E Obasi
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria
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48
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Rustin MH, Gilkes JJ, Robinson TW. Pyoderma gangrenosum associated with Behçet's disease: treatment with thalidomide. J Am Acad Dermatol 1990; 23:941-4. [PMID: 2254485 DOI: 10.1016/s0190-9622(08)80705-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- M H Rustin
- Department of Dermatology, Royal Free Hospital, London, England
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49
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Kang S, Dover JS. Successful treatment of eruptive pyoderma gangrenosum with intravenous vancomycin and mezlocillin. Br J Dermatol 1990; 123:389-93. [PMID: 2206976 DOI: 10.1111/j.1365-2133.1990.tb06300.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- S Kang
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston 02114
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50
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Wong CK, Pun KK, Lum CC, Lee SW, Ng MM, Wang CC. Pyoderma gangrenosum associated with erythroid hypoplasia. Postgrad Med J 1990; 66:312-3. [PMID: 2385558 PMCID: PMC2429404 DOI: 10.1136/pgmj.66.774.312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pyoderma gangrenosum is most commonly associated with inflammatory bowel disease and rheumatoid arthritis, but it has been associated with various haematological malignancies. We describe its association with primary erythroid hypoplasia without thymoma in an 80 year old woman who presented with septicaemia complicating urinary tract infection. Spontaneous healing of an extensive lesion was observed.
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Affiliation(s)
- C K Wong
- Department of Medicine, University of Hong Kong, Queen Mary Hospital
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