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Diaz MJ, Haq Z, Abdi P, Tran JT, Kaffenberger BH. New-onset depression and anxiety in adults with pyoderma gangrenosum: A case-control study with propensity score matching. Int J Dermatol 2024; 63:e95-e97. [PMID: 38406921 DOI: 10.1111/ijd.17044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/01/2024] [Accepted: 01/09/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Michael J Diaz
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Zaim Haq
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Parsa Abdi
- Faculty of Medicine, Memorial University of Newfoundland, St. Johns, NL, USA
| | - Jasmine T Tran
- School of Medicine, Indiana University, Indianapolis, IN, USA
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2
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Zaino ML, Schadt CR, Callen JP, Owen LG. Pyoderma Gangrenosum: Diagnostic Criteria, Subtypes, Systemic Associations, and Workup. Dermatol Clin 2024; 42:157-170. [PMID: 38423678 DOI: 10.1016/j.det.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis with variable clinical features. The classic presentation is an ulceration with an erythematous to violaceous undermined border. Extracutaneous manifestations may occur. Associated systemic diseases include inflammatory bowel disease, inflammatory arthritides, and hematologic disorders. The pathophysiologic mechanism of disease is not completely known but likely related to the cumulative impact of inflammation, immune-mediated neutrophilic dysfunction, and genetic predisposition. Incidence is between 3 and 10 people per million but may be greater due to under recognition. In this article, we will discuss the diagnostic criteria, disease subtypes, systemic associations, and workup.
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Affiliation(s)
- Mallory L Zaino
- Department of Dermatology, University of Louisville, 3810 Springhurst Boulevard, Suite 200, Louisville, KY, USA.
| | - Courtney R Schadt
- Department of Dermatology, University of Louisville, 3810 Springhurst Boulevard, Suite 200, Louisville, KY, USA
| | - Jeffrey P Callen
- Department of Dermatology, University of Louisville, 3810 Springhurst Boulevard, Suite 200, Louisville, KY, USA
| | - Lafayette G Owen
- Department of Dermatology, University of Louisville, 3810 Springhurst Boulevard, Suite 200, Louisville, KY, USA
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3
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Tan MG, Singh N, Kirshen C, Tolkachjov SN. Association between pyoderma gangrenosum and autoimmune connective tissue disorders: A systematic review. Int J Dermatol 2024; 63:e92-e94. [PMID: 38402537 DOI: 10.1111/ijd.17088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Marcus G Tan
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
| | - Nupur Singh
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Carly Kirshen
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
| | - Stanislav N Tolkachjov
- Epiphany Dermatology, Dallas, TX, USA
- Baylor University Medical Center, Dallas, TX, USA
- Department of Dermatology, University of Texas at Southwestern, Dallas, TX, USA
- Texas A&M College of Medicine, Dallas, TX, USA
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4
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Li F, Zhao J, Duan H, Zhang H, Zhang L, Zhao L, Wen Y, Gu X. Pyoderma gangrenosum complicated with hematological malignancies: Two case reports. Medicine (Baltimore) 2024; 103:e37159. [PMID: 38457569 PMCID: PMC10919523 DOI: 10.1097/md.0000000000037159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/12/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Pyoderma gangrenosum (PG) is a rare noninfectious neutrophilic skin disease. The diagnosis of PG is mainly based on clinical manifestations. Therefore, the clinical features of PG are important for confirming the diagnosis of this disease. Herein, the clinical data of 2 young males with PG complicated with hematological malignancies were reported, and the literature were reviewed. CASE PRESENTATION The first case was a 22-year-old male who was admitted due to a systemic rash, headache, and fever. Physical examination showed black scabs on the skins of the extremities, trunk, scalp, and face. Biopsy of the skin lesion showed epidermal edema, spongy formation, neutrophil infiltration, acute and chronic inflammatory cell infiltration in the dermis, showing purulent inflammation with epidermal erosion. The bone marrow biopsy showed obviously active proliferation of nucleated cells, granulocytes at various stages, abnormal morphological neutrophils, and occasionally observed young red blood cells. The diagnosis of PG and chronic myelomonocytic leukemia (CMML-0) was made. The second case was a 28-year-old male who presented a swollen, painful right calf following injury and then developed ulcers on skin and soft tissues. Bone marrow biopsy showed obviously active nucleated cell proliferation, suggesting a myeloid tumor. He was also diagnosed with PG and hematological malignancies. They both received hormone and antiinfection therapy. After treatment, their body temperature, infection, and skin lesions were improved. However, both of them were readmitted and had a poor prognosis. CONCLUSIONS PG may be associated with hematological malignancies. For patients with typical skin lesions and obvious abnormal blood routines, it is necessary to investigate the possibility of PG with hematological malignancies.
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Affiliation(s)
- Fen Li
- Department of Hematology, The First People’s Hospital of Yunnan Province, Yunnan Province Clinical Research Center for Hematologic Disease, Yunnan Province Clinical Center for Hematologic Disease, Kunming, 650032 Yunnan, China
- Department of Hematology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032 Yunnan, China
| | - Jie Zhao
- Department of Hematology, The First People’s Hospital of Yunnan Province, Yunnan Province Clinical Research Center for Hematologic Disease, Yunnan Province Clinical Center for Hematologic Disease, Kunming, 650032 Yunnan, China
- Department of Hematology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032 Yunnan, China
| | - Huanan Duan
- Department of Hematology, The First People’s Hospital of Yunnan Province, Yunnan Province Clinical Research Center for Hematologic Disease, Yunnan Province Clinical Center for Hematologic Disease, Kunming, 650032 Yunnan, China
- Department of Hematology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032 Yunnan, China
| | - Haixi Zhang
- Department of Hematology, The First People’s Hospital of Yunnan Province, Yunnan Province Clinical Research Center for Hematologic Disease, Yunnan Province Clinical Center for Hematologic Disease, Kunming, 650032 Yunnan, China
- Department of Hematology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032 Yunnan, China
| | - Lin Zhang
- Department of Hematology, The First People’s Hospital of Yunnan Province, Yunnan Province Clinical Research Center for Hematologic Disease, Yunnan Province Clinical Center for Hematologic Disease, Kunming, 650032 Yunnan, China
- Department of Hematology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032 Yunnan, China
| | - Liangyun Zhao
- Department of Hematology, The First People’s Hospital of Yunnan Province, Yunnan Province Clinical Research Center for Hematologic Disease, Yunnan Province Clinical Center for Hematologic Disease, Kunming, 650032 Yunnan, China
- Department of Hematology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032 Yunnan, China
| | - Yan Wen
- Department of Hematology, The First People’s Hospital of Yunnan Province, Yunnan Province Clinical Research Center for Hematologic Disease, Yunnan Province Clinical Center for Hematologic Disease, Kunming, 650032 Yunnan, China
- Department of Hematology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032 Yunnan, China
| | - Xuezhong Gu
- Department of Hematology, The First People’s Hospital of Yunnan Province, Yunnan Province Clinical Research Center for Hematologic Disease, Yunnan Province Clinical Center for Hematologic Disease, Kunming, 650032 Yunnan, China
- Department of Hematology, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032 Yunnan, China
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Tyagi M, Verma V, Bhari N, Gupta S. Herpes presenting as pyoderma gangrenosum-like ulcers in a child with AIDS. Int J Dermatol 2024; 63:371-373. [PMID: 38228397 DOI: 10.1111/ijd.17027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/11/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024]
Affiliation(s)
- Mehul Tyagi
- Department of Dermatology and Venereology, AIIMS, New Delhi, India
| | - Vaishnavi Verma
- Department of Dermatology and Venereology, AIIMS, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology and Venereology, AIIMS, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, AIIMS, New Delhi, India
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Satoh TK. Genetic mutations in pyoderma gangrenosum, hidradenitis suppurativa, and associated autoinflammatory syndromes: Insights into pathogenic mechanisms and shared pathways. J Dermatol 2024; 51:160-171. [PMID: 38031879 DOI: 10.1111/1346-8138.17028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023]
Abstract
Pyoderma gangrenosum (PG), hidradenitis suppurativa (HS), and the associated autoinflammatory syndromes, including pyogenic arthritis, pyoderma gangrenosum, and acne (PAPA) syndrome, PSTPIP1-associated myeloid-related proteinemia inflammatory (PAMI) syndrome, pyoderma gangrenosum, acne, and hidradenitis suppurativa (PASH) syndrome, and pyogenic arthritis, pyoderma gangrenosum, acne, and suppurative hidradenitis (PAPASH) syndrome are dermatological conditions characterized by chronic inflammation and tissue damage. Recent advances in genetic research have identified specific mutations associated with these disorders, shedding light on their underlying pathogenic mechanisms. This review aims to summarize the current knowledge of identified mutations and presumed pathophysiology in PG, HS, and the associated autoinflammatory syndromes.
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Affiliation(s)
- Takashi K Satoh
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
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Shakshouk H, deCampos-Stairiker M, Kody S, Stenzel P, Xia E, Mostaghimi A, Wu B, Shinohara MM, Marzano AV, Polly S, Fernandez AP, Ortega-Loayza AG. Mortality and Autopsy Findings in Patients with Pyoderma Gangrenosum: A Multi-Institutional Series. Dermatology 2024; 240:352-356. [PMID: 38185115 DOI: 10.1159/000536145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION Pyoderma gangrenosum (PG) is a rare ulcerative skin condition with an increased risk of mortality compared to the general population. The causes of this increased risk are not well understood. Misdiagnosis is common in PG, and many studies are limited by the inclusion of misdiagnosed cases. The goal of this study was to review autopsy findings, identify causes of death, and identify factors that may worsen outcomes among deceased patients confirmed to have PG. METHODS Data was retrospectively reviewed from the electronic medical records at five academic hospitals. A search was conducted for deceased patients with a diagnosis of PG who had an autopsy performed between 2010 and 2020. We report a descriptive analysis of 11 patients and their clinical characteristics, causes of death, and autopsy findings. RESULTS The average age of death was 62.9 years. Seven patients had at least one underlying condition known to be associated with PG including inflammatory bowel disease, inflammatory arthritis, or a hematologic disorder. The most common cause of death was infection (n = 6, 54.5%), followed by pulmonary embolism (n = 3, 27.3%), and myelodysplastic syndrome (n = 2, 18.2%). Six patients (54.5%) were taking systemic steroids at the time of death. CONCLUSION The development of PG may shorten life expectancy among those with underlying conditions associated with PG, and common treatments for PG may contribute to the risk of fatal complications. Awareness of the risk of infection, thrombosis, and malignancy among those with PG is necessary for proper management. Further research is needed to explore the relationship between PG and thromboembolism.
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Affiliation(s)
- Hadir Shakshouk
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Shannon Kody
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
| | - Peter Stenzel
- Department of Pathology, Oregon Health and Science University, Portland, Oregon, USA
| | - Eric Xia
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bicong Wu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Michi M Shinohara
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
- Division of Dermatology, University of Washington, Seattle, Washington, USA
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Samantha Polly
- Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anthony P Fernandez
- Departments of Dermatology and Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
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8
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Patel S, Hijaz B, Nambudiri VE. Anaemia as a comorbidity in pyoderma gangrenosum hospitalizations. Exp Dermatol 2024; 33:e14925. [PMID: 37726957 DOI: 10.1111/exd.14925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/24/2023] [Accepted: 09/03/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Shrey Patel
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Baraa Hijaz
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Vinod E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Baykal GÖ, Sözeri B. Concurrent pyoderma gangrenosum and Takayasu arteritis in an infant: diagnostic challenges and treatment considerations. Turk J Pediatr 2024; 66:116-123. [PMID: 38523387 DOI: 10.24953/turkjped.2023.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND Takayasu arteritis (TA) is an uncommon chronic inflammatory and autoimmune disease primarily affecting large vessels, particularly the aorta and its branches. Skin manifestations have been documented in association with TA. Pyoderma gangrenosum (PG) is a chronic neutrophilic dermatosis characterized by destructive, necrotizing, and painful ulcers, predominantly found on the lower extremities. The coexistence of PG and TA is extremely rare, with most reported cases involving adult patients. Interestingly, the association between PG and TA appears to be more common in Japan compared to North American and European populations. Childhood TA (c-TA) accompanied by PG is exceptionally rare, with only 10 cases reported in the literature thus far. CASE REPORT We present the case of a 7-month-old patient initially diagnosed with PG. Despite aggressive immunosuppressive therapy, the patient`s high acute phase reactants remained elevated. Although the abdominal ultrasound was normal, advanced imaging was performed due to severe abdominal pain. Contrastenhanced computerized tomography angiography of the aorta and its branches revealed extensive vascular involvement consistent with TA. CONCLUSION In this report, we highlight an infantile case of PG that was subsequently diagnosed as infantile TA. Recognizing the rare association between PG and TA is important. Thorough evaluation and prompt diagnosis of TA in infants with PG can guide further investigations and prevent vascular complications.
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Affiliation(s)
- Gülcan Özomay Baykal
- Clinic of Pediatric Rheumatology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Türkiye
| | - Betül Sözeri
- Clinic of Pediatric Rheumatology, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Türkiye
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10
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Martín-Zamora AC, Miranda-Solis LN, Hidalgo-Matlock B. Pediatric pyoderma gangrenosum with pulmonary involvement: A case report. Pediatr Dermatol 2024; 41:94-95. [PMID: 37367219 DOI: 10.1111/pde.15381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/11/2023] [Indexed: 06/28/2023]
Abstract
Pyoderma gangrenosum is a rare disease in childhood. Extra-cutaneous manifestations are uncommon in pyoderma gangrenosum, even more so in children, with only a few cases reported in the literature. We present the case of a pediatric patient with pyoderma gangrenosum and associated pulmonary involvement. In this case, the diagnosis was delayed leading to late initiation of therapy, emphasizing the importance of maintaining a high level of suspicion for this diagnosis.
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Affiliation(s)
- Ana Camila Martín-Zamora
- Department of Dermatology, Hospital Nacional de Niños, University of Costa Rica, San José, Costa Rica
| | | | - Benjamin Hidalgo-Matlock
- Department of Dermatology, Hospital Nacional de Niños, University of Costa Rica, San José, Costa Rica
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11
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Ma L, Chen X, Guo Q, Qiao Z, Wang N, Pai P, Liu X. Rapid response to spesolimab in a patient with severe refractory pyoderma gangrenosum. Clin Exp Dermatol 2023; 49:82-84. [PMID: 37706345 DOI: 10.1093/ced/llad317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 08/13/2023] [Indexed: 09/15/2023]
Abstract
We report on a patient with severe ulcerative pyoderma gangrenosum that was recalcitrant to systemic corticosteroid, tumour necrosis factor antagonist and ciclosporin treatment and finally controlled when spesolimab was added to the treatment regimen.
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Affiliation(s)
- Li Ma
- Departments of Dermatology
| | | | | | | | | | - Pearl Pai
- Internal Medicine, The University of Hongkong-Shenzhen Hospital, Shenzhen, China
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12
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Zhang L, Zhou M, Lv W, Li T, Xu Y, Liu Z. Metagenomics assists in the diagnosis of a refractory, culture-negative pyoderma gangrenosum-like ulcer caused by Helicobacter cinaedi in a patient with primary agammaglobulinemia. J Microbiol Immunol Infect 2023; 56:1284-1287. [PMID: 37524645 DOI: 10.1016/j.jmii.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 05/31/2023] [Accepted: 07/09/2023] [Indexed: 08/02/2023]
Abstract
Helicobacter cinaedi is known to cause various infections in immunocompromised hosts ranging from skin lesions to disseminated septicemia. Identification of H. cinaedi is difficult through conventional identification methods due to its fastidious nature. We reported a refractory and culture-negative pyoderma gangrenosum-like ulcer caused by H. cinaedi in a patient with primary agammaglobulinemia. Metagenomic next-generation sequencing (mNGS) was applied for the identification of H. cinaedi and prolonged minocycline and amoxicillin-clavulanate potassium was used to eradicate the infection. Given the difficulties in culturing this organism, it's highly possible that H cinaedi infections have been overlooked. We suggest that early consideration of H. cinaedi infection should be suspected in immunocompromised patients presenting with unexplained skin lesions as the appropriate antibiotic choice plus a prolonged treatment course is essential for the prognosis. Application of mNGS could contribute to the early identification of rare and cryptogenic pathogens.
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Affiliation(s)
- Li Zhang
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Menglan Zhou
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - Wei Lv
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Taisheng Li
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yingchun Xu
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China.
| | - Zhengyin Liu
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Smith KN, Welborn M, Monir RL, Motaparthi K, Schoch JJ. Pediatric pyoderma gangrenosum associated with leukocyte adhesion deficiency type 1: A case report and review of the literature. Pediatr Dermatol 2023; 40:1086-1090. [PMID: 37002583 DOI: 10.1111/pde.15292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/26/2023] [Indexed: 06/19/2023]
Abstract
Pyoderma gangrenosum is a rare neutrophilic dermatosis characterized by painful skin ulcers with necrotic, undermined margins. In severe cases, particularly in pediatric patients, work-up for an associated autoimmune, inflammatory, malignant, or genetic disorder should be considered based on the clinical presentation. We report a unique case of pediatric pyoderma gangrenosum with a leukemoid reaction, secondary to an autosomal recessive leukocyte adhesion deficiency type 1.
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Affiliation(s)
- Kristin N Smith
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Macartney Welborn
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Reesa L Monir
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jennifer J Schoch
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
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14
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He R, Zhao S, Cui M, Chen Y, Ma J, Li J, Wang X. Cutaneous manifestations of inflammatory bowel disease: basic characteristics, therapy, and potential pathophysiological associations. Front Immunol 2023; 14:1234535. [PMID: 37954590 PMCID: PMC10637386 DOI: 10.3389/fimmu.2023.1234535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory disease typically involving the gastrointestinal tract but not limited to it. IBD can be subdivided into Crohn's disease (CD) and ulcerative colitis (UC). Extraintestinal manifestations (EIMs) are observed in up to 47% of patients with IBD, with the most frequent reports of cutaneous manifestations. Among these, pyoderma gangrenosum (PG) and erythema nodosum (EN) are the two most common skin manifestations in IBD, and both are immune-related inflammatory skin diseases. The presence of cutaneous EIMs may either be concordant with intestinal disease activity or have an independent course. Despite some progress in research on EIMs, for instance, ectopic expression of gut-specific mucosal address cell adhesion molecule-1 (MAdCAM-1) and chemokine CCL25 on the vascular endothelium of the portal tract have been demonstrated in IBD-related primary sclerosing cholangitis (PSC), little is understood about the potential pathophysiological associations between IBD and cutaneous EIMs. Whether cutaneous EIMs are inflammatory events with a commonly shared genetic background or environmental risk factors with IBD but independent of IBD or are the result of an extraintestinal extension of intestinal inflammation, remains unclear. The review aims to provide an overview of the two most representative cutaneous manifestations of IBD, describe IBD's epidemiology, clinical characteristics, and histology, and discuss the immunopathophysiology and existing treatment strategies with biologic agents, with a focus on the potential pathophysiological associations between IBD and cutaneous EIMs.
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Affiliation(s)
- Ronghua He
- Department of Gastroenterology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Subei Zhao
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingyu Cui
- Department of Gastroenterology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yanhao Chen
- Department of Gastroenterology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jinrong Ma
- Department of Gastroenterology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jintao Li
- Department of Gastroenterology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Xiaodong Wang
- Department of Gastroenterology, The Second Hospital of Jilin University, Changchun, Jilin, China
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Bugaut H, Barete S, Bagot M, Bouaziz JD, Le Pelletier de Glatigny F, Gallien Y, Biard L, Domont F, Cacoub P, Saadoun D, Comarmond C. Neutrophilic dermatosis and hidradenitis suppurativa in patients with Behçet's disease: A neutrophilic disease in the spectrum of autoinflammatory syndromes. Semin Arthritis Rheum 2023; 61:152224. [PMID: 37207416 DOI: 10.1016/j.semarthrit.2023.152224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Association of neutrophilic dermatosis (ND), hidradenitis suppurativa (HS) and Behçet's disease (BD) and shared efficacy of TNFα axis blockade suggests common physiopathology. OBJECTIVES To investigate the clinical features and therapeutic response of ND and HS associated with BD. METHODS We identified 20 patients with ND or HS associated with BD among 1462 patients with BD. RESULTS We analysed 20 (1.4%) patients diagnosed with ND or HS associated with BD: 13 HS, 6 pyoderma gangrenosum (PG), and 1 SAPHO. Our 6 PG cases over 1462 BD patients accounts for 400/100 000 prevalence. Thirteen had bipolar aphthosis, 6 vascular, 5 neurologic, and 4 ocular involvements. All PG occurred on limbs and had typical histology with constant dermal neutrophilic infiltrate. All HS had the classical axillary-mammary phenotype. Sixty-nine percent (69%) of HS were Hurley 1 stage. Treatment consisted mainly in colchicine (n = 20), glucocorticoids (n = 12), and anti-TNFα (n = 9). Interesting results with complete or partial responses were obtained with anti-TNFα (9 cases), ustekinumab (3 cases) and tocilizumab (1 case) to treat refractory ND or HS associated with BD. CONCLUSION PG seems overrepresented in patients with BD. Biotherapies such as anti-TNFα, ustekinumab and tocilizumab appear to be promising to treat refractory ND or HS associated with BD.
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Affiliation(s)
- Hélène Bugaut
- Department of Internal Medicine and Clinical Immunology, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75013 Paris France, Centre de référence Maladies Autoimmunes systémiques rares, Centre de référence Maladies Autoinflammatoires et amylose, 83 boulevard de l'hôpital, Paris 75013, France
| | - Stéphane Barete
- Unit of Dermatology, Pitié-Salpêtrière Hospital, APHP, DMU3ID, Sorbonne Université, Paris 75013, France
| | - Martine Bagot
- Dermatology, Saint-Louis Hospital, Université Paris Cité, Paris 75010, France
| | - Jean-David Bouaziz
- Dermatology, Saint-Louis Hospital, Université Paris Cité, Paris 75010, France
| | | | - Yves Gallien
- Biostatistic, Saint-Louis Hospital, Université Paris Cité, Paris 75010, France
| | - Lucie Biard
- Biostatistic, Saint-Louis Hospital, Université Paris Cité, Paris 75010, France
| | - Fanny Domont
- Department of Internal Medicine and Clinical Immunology, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75013 Paris France, Centre de référence Maladies Autoimmunes systémiques rares, Centre de référence Maladies Autoinflammatoires et amylose, 83 boulevard de l'hôpital, Paris 75013, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75013 Paris France, Centre de référence Maladies Autoimmunes systémiques rares, Centre de référence Maladies Autoinflammatoires et amylose, 83 boulevard de l'hôpital, Paris 75013, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75013 Paris France, Centre de référence Maladies Autoimmunes systémiques rares, Centre de référence Maladies Autoinflammatoires et amylose, 83 boulevard de l'hôpital, Paris 75013, France.
| | - Cloé Comarmond
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, Paris 75010, France
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16
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Düzenli T. Prediagnosis of soft tissue infection that was finally diagnosed as pyoderma gangrenosum of ulcerative colitis. Rev Esp Enferm Dig 2023; 115:464. [PMID: 36412491 DOI: 10.17235/reed.2022.9332/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Pyoderma gangrenosum is a rare disorder characterized by inflammatory and ulcerative skin lesions. In this case report, we aimed to present our patient who had a prediagnosis of soft tissue infection and skin ulcers, and was eventually diagnosed with ulcerative colitis-associated pyoderma gangrenosum. A 30-year-old female patient was admitted to the emergency department with skin lesions on her kneecap and lower neck. The patient's skin lesions were considered as infective ulcers, and the patient was admitted to the infectious diseases clinic. The patient had received antibiotics of meropenem and teicoplanin in the follow-up. Surgical debridement was performed but after debridement, the wound had progressed.
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Affiliation(s)
- Tolga Düzenli
- Gastroenterology, SBU Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Turkey
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17
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King BJ, Montagnon CM, Brough K, Wetter DA, Tolkachjov SN. Neutrophilic dermatosis of the dorsal hands is commonly associated with underlying hematologic malignancy and pulmonary disease: A single-center retrospective case series study. J Am Acad Dermatol 2023; 88:444-446. [PMID: 35618151 DOI: 10.1016/j.jaad.2022.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 01/17/2023]
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18
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Bhowmick K, Roongta R, Dey S, Dey S, Mondal S, Sinhamahapatra P, Ghosh P, Ghosh B. Refractory Takayasu arteritis with recurrent pyoderma gangrenosum: a therapeutic challenge with case-based review. Clin Rheumatol 2023; 42:1469-1477. [PMID: 36637635 DOI: 10.1007/s10067-023-06506-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023]
Abstract
Takayasu arteritis (TA) is an uncommon chronic granulomatous large-vessel vasculitis affecting the aorta and its branches. Pyoderma gangrenosum (PG) is a chronic neutrophilic dermatosis characterized by rapidly developing painful ulcers. The association of PG with TA is relatively uncommon. We report a case of a 22-year-old lady with a history of recurrent pyoderma lesions for 4 months following which she developed right upper limb claudication. She underwent contrast-enhanced magnetic resonance angiography of the aorta and its branches and was initially diagnosed with type IIb TA. She was put on prednisolone and methotrexate but had a major relapse with new-onset lower limb claudication despite an appropriate course of immunosuppression. She was planned for tocilizumab infusion 8 mg/kg intravenous every 4 weeks. Following the first dose of tocilizumab, her vascular symptoms improved but she had a flare of PG. This was followed by another flare after the second dose. She was switched to tofacitinib which led to sustained remission of her TA activity and healing of her skin lesions, and the prednisolone dose could be reduced to 5 mg daily over the next 1 year. Various immunosuppressives were used to date for treating PG in TA. However, tofacitinib is being reported for the first time in literature for treating PG and controlling TA activity. The paradoxical flare of PG with tocilizumab is quite uncommon and is also reported in our case with literature review.
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Affiliation(s)
- Kaustav Bhowmick
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Rashmi Roongta
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Soumya Dey
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Sonali Dey
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Sumantro Mondal
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Pradyot Sinhamahapatra
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Parasar Ghosh
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Biswadip Ghosh
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India.
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19
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Ilyas F. Successful low-dose corticosteroid treatment of aggressive pyoderma gangrenosum with irritable bowel syndrome: a case report. Acta Dermatovenerol Alp Pannonica Adriat 2022; 31:111-114. [PMID: 36149041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare and chronic cutaneous disorder characterized by painful ulcers that progresses rapidly. The disease is thought to be immune-mediated. However, the exact etiopathogenesis of the disease has yet to be clearly established. The disease is often misdiagnosed as other cutaneous disorders, most notably infections such as cellulitis in its initial stage. Failure of antibiotic treatment is one of the signs when a diagnosis of PG should be considered. Due to its rampant lesion evolution, aggressive corticosteroid therapy has long been used as the mainstay treatment for PG. However, this can lead to side effects such as gastrointestinal bleeding, especially in patients with autoimmune diseases such as inflammatory bowel disease (IBD). We report the case of a 54-year-old female patient with PG that was initially misdiagnosed as cellulitis and furunculosis along with IBD. She was treated using a low-dose regimen of methylprednisolone, which resulted in significant clinical improvement and complete resolution after 2 months of therapy.
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Affiliation(s)
- Faridha Ilyas
- Department of Dermatology and Venereology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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20
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Malachowski SJ, Latour E, Ortega-Loayza AG. Clinical and laboratory factors associated with wound healing in patients with pyoderma gangrenosum: a retrospective study. Wounds 2022; 34:178-184. [PMID: 35767845 DOI: 10.25270/wnds/2022.0408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Pyoderma gangrenosum (PG) is a rare, chronic, inflammatory, and ulcerative condition that often affects the lower extremities. Laboratory markers such as neutrophil-to-lymphocyte ratio, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level may have prognostic utility in the management of ulcerative or inflammatory conditions. OBJECTIVE This exploratory analysis investigated the relationship between readily available clinical factors and target ulcer healing within 6 months from the first visit. METHODS Two logistic regression models were fit-one focused on ESR as a primary predictor adjusted for age and hemoglobin level, and the other focused on CRP level adjusted for body mass index (BMI) and smoking history. RESULTS The odds of wound healing at 6 months for patients with abnormal CRP was 0.19 times the odds of healing (95% CI, 0.03-0.77) for those with normal CRP (<10 mg/L), after accounting for BMI and smoking. Similarly, after accounting for age and hemoglobin, those with high ESR experienced 2.81 times the odds of healing (95% CI, 0.69-14.58) at 6 months compared with patients with normal ESR. CONCLUSIONS After adjustment, an increased CRP level was associated with lower odds of healing; however, further research is warranted to investigate its prognostic utility. The relationship between ESR and odds of healing should be interpreted with caution because the wide 95% CI for the adjusted odds ratio reflects marked uncertainty in the estimate. This research brief may inform investigations into inflammatory markers as possible prognostic markers for wound healing in patients with PG.
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Affiliation(s)
| | - Emile Latour
- Oregon Health and Sciences University, Portland, OR; Knight Cancer Institute Biostatistics Shared Resource, Portland, OR
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21
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Akagi Y, Yamagiwa Y, Shirai H, Suzuki T, Tsuru I, Ishikawa A, Akiyama N, Ogura M, Kobayashi K, Bae Y, Suemitsu Y, Imakado S, Mawatari M, Ueda A. Aseptic Cavernosal Abscess: An Unrecognized Feature of Neutrophilic Dermatosis. Intern Med 2022; 61:917-921. [PMID: 34483210 PMCID: PMC8987252 DOI: 10.2169/internalmedicine.7994-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 50-year-old man developed a sterile cavernosal abscess followed by prominent features of necrotizing neutrophilic dermatosis. We conducted a literature review, which revealed that aseptic abscesses in the corpus cavernosum occur in association with neutrophilic dermatosis. Patients with this condition frequently receive unnecessary antibiotic treatment and surgical interventions. Although this condition responds to systemic corticosteroids, the functional prognosis of the penis is poor. Abscess formation may be the initial presentation of neutrophilic dermatoses, and underlying conditions may even be absent. Clinicians need to be aware of this condition to distinguish it from bacterial infection and initiate early disease-specific treatments.
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Affiliation(s)
- Yu Akagi
- Department of Infectious Diseases, Japanese Red Cross Medical Center, Japan
| | - Yuri Yamagiwa
- Department of Allergology and Rheumatology, Japanese Red Cross Medical Center, Japan
| | - Harumi Shirai
- Department of Allergology and Rheumatology, Japanese Red Cross Medical Center, Japan
| | - Takeshi Suzuki
- Department of Allergology and Rheumatology, Japanese Red Cross Medical Center, Japan
| | - Ibuki Tsuru
- Department of Urology, Japanese Red Cross Medical Center, Japan
| | - Akira Ishikawa
- Department of Urology, Japanese Red Cross Medical Center, Japan
| | - Naoki Akiyama
- Department of Dermatology, Japanese Red Cross Medical Center, Japan
| | - Mizuki Ogura
- Department of Hematology, Japanese Red Cross Medical Center, Japan
| | - Kanae Kobayashi
- Department of Ophthalmology, Japanese Red Cross Medical Center, Japan
| | - Yuan Bae
- Department of Pathology, Japanese Red Cross Medical Center, Japan
| | - Yamato Suemitsu
- Department of Pathology, Japanese Red Cross Medical Center, Japan
| | - Sumihisa Imakado
- Department of Dermatology, Japanese Red Cross Medical Center, Japan
| | - Momoko Mawatari
- Department of Infectious Diseases, Japanese Red Cross Medical Center, Japan
| | - Akihiro Ueda
- Department of Infectious Diseases, Japanese Red Cross Medical Center, Japan
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22
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Kita A, Hashimoto Y, Sato K, Itoi Y, Kasuga K, Tanaka H, Hosaka H, Kuribayashi S, Uraoka T. [Ulcerative colitis complicated by pyoderma gangrenosum and multiple aseptic abscesses]. Nihon Shokakibyo Gakkai Zasshi 2022; 119:1014-1021. [PMID: 36351620 DOI: 10.11405/nisshoshi.119.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A woman in her 30s was diagnosed with ulcerative colitis (UC) 4 years ago and treated with tacrolimus, azathioprine, and prednisolone 5mg (PSL). Skin ulcers appeared on the right lower leg during the course of treatment, diagnosed as pyoderma gangrenosum (PG). The patient initially improved with an increased PSL and infliximab dose, but then developed multiple skin ulcers and folliculitis throughout her body. She was transferred to our hospital for PG exacerbation treatment. She developed fever after transfer and contrast-enhanced computed tomography showed multiple abscesses in the lungs and kidneys. PSL was decreased and infliximab was discontinued. Antibiotic therapy and granulocyte/monocyte apheresis (GMA) were started. Fever persisted even after antibiotic treatment, and her general condition did not improve. A right renal abscess puncture was performed. Pus was sterile. A sterile abscess associated with PG was suspected. The PSL dose was increased to 1mg/kg and infliximab restarted. Thereafter, the patient's general condition improved, and both lung and renal abscesses contracted. Skin ulcer epithelialization was also observed. Abdominal symptoms were mild during the course of the disease, and colonoscopy showed only a localized ulcerative lesion in the rectum. The patient was later transferred to the department of dermatology at our hospital for PG treatment. Aseptic abscesses are caused by neutrophil infiltration without infection and have been reported to be associated with neutrophilic dermatosis and inflammatory bowel disease. UC-associated aseptic abscess is rare. This is only the sixth case in Japan. Aseptic abscesses can occur in various sites, including subcutaneous and deep organs, but this is the first kidney abscess case. In previous reports, PSL, infliximab, colchicine, and infliximab+GMA were used for aseptic abscesses associated with UC. They all showed abscess reduction. Aseptic abscesses associated with PG should be considered if abscess lesions occur during the course of UC, and a treatment strategy including enhanced immunosuppression should be considered.
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Affiliation(s)
- Aoi Kita
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
| | - Yu Hashimoto
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
| | - Keigo Sato
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
| | - Yuki Itoi
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
| | - Kengo Kasuga
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
| | - Hirohito Tanaka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
| | - Hiroko Hosaka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
| | - Shiko Kuribayashi
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine
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23
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Piqué-Duran E, Morera Molina J, Limeres-González MÁ, Espejo-Gil AM. Cranial aseptic osteomyelitis associated with pyoderma gangrenosum. Neurocirugia (Astur : Engl Ed) 2022; 33:46-50. [PMID: 34955434 DOI: 10.1016/j.neucie.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 11/21/2020] [Indexed: 06/14/2023]
Abstract
Neutrophilic dermatoses include a heterogeneous group of entities. Uncommonly, they can accumulate aseptic neutrophilic abscesses in other tissues in addition to the skin. A 34-year-old female complained of a headache which was unresponsive to usual drugs. A TAC revealed an osteolytic lesion in the right parietal bone. The biopsy showed osteomyelitis. One year later, pyoderma gangrenosum appeared in the anterior aspect of both legs. The headache and the cutaneous lesions disappeared after treatment with oral prednisone. The bone involvement in the background of neutrophilic dermatoses is exceptional. Usually, it involves children in the context of chronic recurrent multiple osteomyelitis (CRMO). Only two cases have been described in adults. One of them was a 26-year-old woman who had had CRMO since childhood, and the other one in contiguity with the cutaneous lesions of pyoderma gangrenosum.
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Affiliation(s)
- Enric Piqué-Duran
- Sección de Dermatología, Hospital Dr. José Molina Orosa, Lanzarote, Provincia de Las Palmas, Spain.
| | - Jesús Morera Molina
- Servicio de Neurocirugía, Hospital Universitario de Gran Canaria Doctor Negrín, Provincia de Las Palmas, Spain
| | | | - Ana María Espejo-Gil
- Servicio de Medicina Interna, Hospital Dr. José Molina Orosa, Lanzarote, Provincia de Las Palmas, Spain
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24
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Jang HJ, Suh HR, Choi S, Hong SJ, Cho SM, Choi KH, Choe BH, Kang B. Severe Disease Activity Based on the Paris Classification Is Associated with the Development of Extraintestinal Manifestations in Korean Children and Adolescents with Ulcerative Colitis. J Korean Med Sci 2021; 36:e278. [PMID: 34783212 PMCID: PMC8593413 DOI: 10.3346/jkms.2021.36.e278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/22/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There are limited data regarding the extraintestinal manifestations (EIMs) associated with pediatric inflammatory bowel disease (IBD) in Korea. We aimed to investigate the clinical features and factors associated with the development of EIMs in Korean children and adolescents with IBD. METHODS This multicenter, retrospective study was conducted from 2010 to 2017. Baseline clinicodemographic, laboratory findings, disease activity, disease phenotypes, and EIMs were investigated. RESULTS A total of 172 patients were included. One-hundred thirty-seven (79.7%) had Crohn's disease (CD), and 35 (20.3%) had ulcerative colitis (UC). EIMs occurred in 42 patients (24.4%). EIMs developed in 34/137 diagnosed with CD (24.8%), and in 8/35 diagnosed with UC (22.9%), during a median follow-up duration of 3.2 (interquartile range, 1.9-5.4) years for CD and 3.0 (1.0-4.0) years for UC, respectively. Arthritis/arthralgia was most commonly observed (n = 15, 35.7%), followed by stomatitis/oral ulcer (n = 10, 23.8%), hepatitis (n = 5, 11.9%), nephritis (n = 4, 9.5%), pancreatitis (n = 2, 4.8%), erythema nodosum (n = 2, 4.8%), pyoderma gangrenosum (n = 1, 2.4%), primary sclerosing cholangitis (n = 1, 2.4%), uveitis (n = 1, 2.4%), and ankylosing spondylitis (n = 1, 2.4%). A significant difference in disease severity based on the Paris classification (P = 0.011) and ESR at diagnosis (P = 0.043) was observed between the EIM positive and negative group in patients with UC. According to logistic regression analyses, S1 disease severity based on the Paris classification was the only factor that was significantly associated with the development of EIMs (odds ratio, 16.57; 95% confidence interval, 2.18-287.39; P = 0.017). CONCLUSION Severe disease activity based on the Paris classification in pediatric patients with UC was significantly associated with EIM development. As disease severity in the Paris classification is a dynamic parameter, treatment should be focused on disease control to minimize the occurrence of EIMs in Korean children and adolescents with UC.
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Affiliation(s)
- Hyo-Jeong Jang
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
| | - Hyo Rim Suh
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sujin Choi
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Suk Jin Hong
- Department of Pediatrics, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Seung-Man Cho
- Department of Pediatrics, Dongguk University School of Medicine, Gyeongju, Korea
| | - Kwang-Hae Choi
- Department of Pediatrics, Yeungnam University School of Medicine, Daegu, Korea
| | - Byung-Ho Choe
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea.
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25
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Elkhatib R, Giunta G, Hanssens V, Kapila A, De Baerdemaeker R, Zeltzer A, Hamdi M. Case Report of Two Patients With COVID-19 and Sacral Pressure Injuries Associated with Pyoderma Gangrenosum. Adv Skin Wound Care 2021; 34:438-443. [PMID: 33871408 DOI: 10.1097/01.asw.0000744356.54317.c2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT During the COVID-19 pandemic, an increasing number of patients have been admitted to the ICU with severe respiratory complications requiring prolonged supine positioning. Recently, many case reports have been published regarding dermatologic manifestations associated with COVID-19. However, there is little information about the clinical features of these manifestations. Pyoderma gangrenosum (PG) is an ulcerative noninfectious inflammatory disease of the skin. In at least 50% of the cases, the etiology is unknown. Nevertheless, PG is associated with many systemic diseases. In this article, the authors report two critically ill patients with COVID-19 who developed sacral ulcers during their recovery in the ICU. These ulcers had an atypical course and were exacerbated by surgical debridements. Accordingly, providers suspected PG, which was confirmed by the clinical evolution of the ulcers and biopsies taken from the wounds. To the best of the authors' knowledge, no previous articles have reported sacral pressure injuries associated with PG in patients with COVID-19. Providers should suspect PG in patients with COVID-19 who develop nonhealing pressure injuries.
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Affiliation(s)
- Rania Elkhatib
- In the Department of Plastic and Reconstructive Surgery, University Hospital Brussels, Belgium, Rania Elkhatib, MD, is Attending Physician; Gabriele Giunta, MD, FEBOPRAS, is Consultant; Valerie Hanssens, MSc, is Nurse Specialist; Ayush Kapila, MD, MRCS, is Resident; Randy De Baerdemaeker, MD, FEBOPRAS, is Consultant; Assaf Zeltzer, MD, PhD, is Consultant; and Moustapha Hamdi, MD, PhD, is Head of Department. Acknowledgment: Drs Elkhatib and Giunta contributed equally to this work. The authors have disclosed no financial relationships related to this article. Submitted September 2, 2020; accepted in revised form October 28, 2020; published online ahead of print April 16, 2021
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26
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Kawai M, Kawanami C, Fukuda A, Seno H. Pyoderma gangrenosum with primary sclerosing cholangitis-associated colitis successfully treated with concomitant granulocyte and monocyte adsorption apheresis with corticosteroids. Clin J Gastroenterol 2021; 14:1561-1566. [PMID: 34101129 DOI: 10.1007/s12328-021-01460-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/03/2021] [Indexed: 12/12/2022]
Abstract
An 18-year-old woman was admitted to our hospital with fever, diarrhea and painful skin ulcers in both pretibial areas starting 19 days earlier. The skin lesions appeared deep necrotic ulcers with violaceous undermined borders. She had been diagnosed as ulcerative colitis and primary sclerosing cholangitis (PSC) 6 and 5 years before, respectively, and had stopped having regular check-up and refused medication for years. Her clinical history and skin lesions led us to suspect of pyoderma gangrenosum (PG). The skin biopsy showed aseptic abscess formation with neutrophils infiltration in the dermis without bacteria. Thus, she was diagnosed with PG. 1 mg/kg/day of prednisolone was administered and ten sessions of granulocyte and monocyte adsorption apheresis (GMA) were started. Magnetic resonance cholangiography showed multifocal bile duct strictures due to PSC. Total colonoscopy revealed ulcerative pancolitis with spared normal mucosa in the rectum. After the treatments, her symptoms and the skin lesion improved dramatically. She was discharged on the 45th day with 25 mg/day of prednisolone. In conclusion, this is the first reported case of PG with PSC-associated colitis that showed dramatic response to the concomitant GMA therapy with corticosteroids. Together with previous reports, concomitant GMA therapy with corticosteroids may be an effective treatment for PG.
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Affiliation(s)
- Munenori Kawai
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Chiharu Kawanami
- Department of Gastroenterology, Otsu Red Cross Hospital, Otsu, Shiga, Japan
| | - Akihisa Fukuda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Affiliation(s)
- F-C Liu
- Division of Gastroenterology, Department of Internal Medicine
| | - N-T Liu
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Chenggong Rd., Neihu District, Taipei 11490, Taiwan
| | - T-Y Huang
- Division of Gastroenterology, Department of Internal Medicine
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Irie K, Yamamoto M, Kikuchi N, Yamamoto T. Granulomatous pyoderma gangrenosum in a patient with ulcerative colitis. Dermatol Online J 2020; 26:13030/qt505032kr. [PMID: 32621701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023] Open
Abstract
A 34-year-old woman with a past history of inflammatory bowel disease developed a painful elevated edematous swelling with ulcerations on the dorsum of her left foot. Histopathological examination revealed dense infiltration of neutrophils and mononuclear cells in the lower dermis and subcutaneous tissue. Tumor necrosis factor (TNF) was strongly detected in giant cells. To date, only a few cases of pyoderma gangrenosum with granulomatous changes have been reported. Tumor necrosis factor may have played a role in the granulomatous reaction in our case.
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Affiliation(s)
- Kinuko Irie
- Department of Dermatology, Fukushima Medical University, Fukushima.
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Machan A, Azendour H, Frikh R, Hjira N, Boui M. The dilemma of treating pyoderma gangrenosum associated with monoclonal gammopathy of undetermined significance. Dermatol Online J 2020; 26:13030/qt1bk7d8hj. [PMID: 32621712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a rare ulcerative skin condition. It can be associated with a number of systemic diseases. Association with monoclonal gammopathy of undetermined significance (MGUS) is uncommon, but prognosis may be different depending upon the type of MGUS. Cases of MGUS- related PG reported in the literature with data concerning evolution and treatment were identified through a PubMed search. A patient with recurrent PG in the setting of a MGUS-IgA-? in our department was also included. In total, 10 cases were identified. Only the two cases with Ig populations other than IgA improved without recurrence after treatment of the PG. All the patients with MGUS-IgA showed recurrences. Early multiple myeloma was proposed for three patients with MGUS-IgA-related PG. Second or third line treatments were necessary in some cases.
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Affiliation(s)
- Achraf Machan
- Department of Dermatology, Mohammed V Military Hospital, Mohammed V university of Rabat, Rabat.
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Morse DC, Patel PM, Haag C, Ortega-Loayza AG. Successful Mastectomy and Chemotherapy in a Patient with Breast Cancer and Active Generalized Pyoderma Gangrenosum. Wounds 2020; 32:E19-E22. [PMID: 32335517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Pyoderma gangrenosum (PG) is a rare, ulcerating neutrophilic dermatosis often associated with inflammatory bowel disease, rheumatoid arthritis, and myeloproliferative disorders. The classic description of PG includes irregularly shaped ulcers with undermined edges with a gun-metal gray or violaceous hue. The etiology remains unclear but appears to be related to genetically predisposed dysregulation of the innate immune system. Diagnosis of PG can be difficult as it can present with symptoms similar to cutaneous infections including erythema, edema, ulceration, fever and leukocytosis. Surgical procedures are generally contraindicated in patients with PG due to the risk of pathergy, excessive cutaneous injury, or ulceration in response to trauma. CASE REPORT The authors report the development of PG with the initiation of chemotherapy in a 46-year-old woman with breast cancer. The patient had a complicated clinical course after multiple surgical debridements due to an initial misdiagnosis of necrotizing fasciitis. The patient's rapid onset of post-procedural ulceration was consistent with the pathergy of PG. The diagnosis of PG was confirmed by skin biopsy, which revealed a diffuse neutrophilic infiltrate, and with the patient's negative cultures and response to steroids. The patient was treated with perioperative prednisone and intravenous immunoglobulin prior to a mastectomy for her breast cancer. The surgery was not complicated by pathergy. CONCLUSIONS This unique case highlights the challenging aspects in the medical and perioperative management of active PG in a patient with breast cancer.
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Affiliation(s)
- Daniel C Morse
- Department of Dermatology, McGovern School of Medicine at the University of Texas Health Sciences Center at Houston, Houston TX
| | - Payal M Patel
- Department of Dermatology, St. Louis University School of Medicine, St. Louis, MO
| | - Carter Haag
- Department of Dermatology and Wound care and Hyperbaric Medicine, Oregon Health and Science University, Portland, OR
| | - Alex G Ortega-Loayza
- Department of Dermatology and Wound care and Hyperbaric Medicine, Oregon Health and Science University, Portland, OR
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Niu R, Zheng J, Ding D, Kuang W, Lu F, Yin X. Giant pyoderma gangrenosum in a patient with ulcerative colitis: A case report. Medicine (Baltimore) 2020; 99:e18795. [PMID: 32028391 PMCID: PMC7015628 DOI: 10.1097/md.0000000000018795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Pyoderma gangrenosum (PG) is a phenomenon of cutaneous ulceration with unknown etiology. About half the cases have associated extracutaneous manifestations or associated systemic diseases. The most commonly associated systemic disorders include inflammatory bowel disease (IBD), hematologic malignancies, autoimmune arthritis, and vasculitis. This is a case report about giant PG with ulcerative colitis (UC), which is extremely rare. CASE PRESENTATION A 39-year-old female farmer with UC for the past 3 years presented with multiple painful ulcers, erosion, exudation, and crusting on the right leg for 1 month. A cutaneous examination showed diffusely distributed, multiple, well-defined, deep purulent ulcers on the right medial shank measuring 6 to 20 cm and sporadic worm-eaten ulceration on the right ectocnemial, with severe oozing and erosions. The ulcerations exhibited deep undermined borders, granulated tissue and a black eschar at the base. The right shank and feet were severely swollen, restricting movement. The arteria dorsalis pedis pulse was good, with normal sensation on the skin of the right shank and feet. Laboratory examinations showed a white cell count of 11.8 × 109/L, hemoglobin was 91 g/L, erythrocyte sedimentation rate was 82 mm/h, unelevated procalcitonin, serum C-reactive protein was 131.29 mg/L, and a negative tuberculin skin test. Enteroscopy demonstrated endoscopic evidence of UC. A skin lesion biopsy showed superficial erosion and scarring. Partial epidermal hyperplasia, partial epidermal atrophy and thinning, mild edema of the dermal papill. Most of the middle and lower part of the dermis, showed dense lymphocytes, histiocytes, multinucleated giant cells, and neutrophil infiltration. PG with UC was diagnosed based on clinical manifestations, laboratory examinations and enteroscopy results. INTERVENTIONS She was treated with topical applications of povidone iodine and kangfuxin solution twice daily, methylprednisolone sodium succinate 40 mg and compound glycyrrhizin 60 mg via intravenous drip once a day, along with thalidomide 50 mg twice daily. The UC was controlled with mesalazine. OUTCOMES She required multiple therapies to achieve PG healing 3 months later. No PG recurrence was observed during the 1-year follow-up. CONCLUSION Recognizing the clinical features of PG and its pathogenic nature, ensuring timely management fundamental for preventing severe destruction and deformity, and control of associated diseases are important aspects of treatment. Combination therapy is essential for PG patients with IBD.
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Montagnon CM, Fracica EA, Patel AA, Camilleri MJ, Murad MH, Dingli D, Wetter DA, Tolkachjov SN. Pyoderma gangrenosum in hematologic malignancies: A systematic review. J Am Acad Dermatol 2019; 82:1346-1359. [PMID: 31560977 DOI: 10.1016/j.jaad.2019.09.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/15/2019] [Accepted: 09/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a devastating neutrophilic dermatosis that may be associated with trauma or systemic diseases. The associations, characteristics, and temporal relationship of PG with hematologic malignancies are not well understood. OBJECTIVE We performed a systematic review of PG associated with hematologic malignancies using data from case reports, case series, and retrospective studies. METHODS We searched MEDLINE, EMBASE, Scopus, and Web of Science from each database's inception to December 12, 2018. Two reviewers independently selected studies and extracted data. RESULTS Two hundred seventy-nine publications met the inclusion criteria (340 cases). Myelodysplastic syndrome (MDS) was the most commonly reported hematologic malignancy associated with PG, followed by monoclonal gammopathy of undetermined significance and acute myeloid leukemia. The mean age of patients was 56.5 years, with males being more common. There was a predominance of the ulcerative PG subtype and multifocal distributions across all hematologic malignancies. The majority of MDS cases preceded PG, which was reversed for MGUS. LIMITATIONS The data were limited by reporting bias because PG subtypes rely on the rendered diagnosis reported. In addition, the classification for hematologic malignancies has evolved since 1978. CONCLUSION Patients with PG should be evaluated for hematologic malignancies, with MDS being the most common.
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Affiliation(s)
| | | | - Archna A Patel
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - David Dingli
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - David A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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Borda LJ, Mervis JS, Kirsner RS. Unilateral granuloma annulare in association with pyoderma gangrenosum and chronic lymphocytic leukemia. Dermatol Online J 2019; 25:13030/qt62c9d1ws. [PMID: 30982302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 06/09/2023] Open
Abstract
Granuloma annulare (GA) is a fairly common inflammatory skin condition with a range of clinical subtypes. We describe an unusual case of unilateral GA confined to the thigh on a previously amputated limb. A man in his 80s with a past medical history of below-knee amputation of the left leg owing to severe leg ulcers from pyoderma gangrenosum, chronic lymphocytic leukemia, and dyslipidemia developed a slowly spreading eruption on the distal stump spreading proximally. On physical examination, he had numerous non-scaly violaceous papules and annular plaques from the stump to the lateral, medial, and anterior thigh. Histology confirmed a diagnosis of GA. The extensive, chronic lesions make this presentation of GA very unusual in that it shares features of both localized and generalized forms. Moreover, the temporal and spatial association with pyoderma gangrenosum is unique and may reflect a related inflammatory pathway.
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Affiliation(s)
| | | | - Robert S Kirsner
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida.
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Eberspacher C, Mascagni D, Fralleone L, Maturo A, Di Matteo FM, De Cristofaro F, Merletti D, Santoro A, Mascagni P, Pontone S, Pironi D. Colocutaneous fistula through ulcerative colitis and cancer to the pyoderma gangrenosum: a never-ending story for a single patient. Case report. G Chir 2019; 40:39-43. [PMID: 30771797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Inflammatory bowel diseases may be associated with many extraintestinal complications, that in some cases can represent the first onset of these disorders. In particular during the course of the disease, Ulcerative Colitis develops extraintestinal manifestations very frequently. One of the rarest is pyoderma gangrenosum, a noninfectious neuthrophilic dermatosis, that can involve most commonly legs but also other parts of the skin or mucosas. It can be idiopathic or associated with gammopathies, vasculitis, chronic arthritis or, like in our case, with inflammatory bowel disease and malignancies. CASE PRESENTATION A 38-year-old man was referred to our Department with a colo-cutaneous fistula in the left quadrant of abdominal wall. In the anamnesis he reported a trauma during a soccer match three weeks before. Through a CT scan and endoscopy with biopsy an inflammatory bowel disease with a segmental colitis and stenosis was diagnosed. After medical therapy, an initial radiological drainage and a period of parenteral nutrition, he underwent a left hemicolectomy. Despite the previous endoscopic biopsy the histopathological examination put in evidence not only inflammatory disease (in particular Ulcerative Colitis) but also a colorectal tumor pT4pN0. After the full recovery before chemotherapy he has developed on the chest and on the abdomen some painful nodules, with central necrosis, one of those in contact with one of the ribs. Through TC and RM it was impossible to understand the precise nature of these skin lesions. With biopsy a pyoderma gangrenosum was diagnosed and treated until complete resolution. DISCUSSION AND CONCLUSION Management of inflammatory bowel diseases can be a true challenge, not only for the intestinal manifestations, but also for all the other features not related to gut. In some cases the same patient can develop many complications, such as malignancies or rare cutaneous diseases. Despite the initial surprise for such a weird evolution in a same patient, from fistula to inflammatory disease to cancer and finally to pyoderma gangrenosum, to face every single complication following consolidated diagnostic and pathological paths has been the correct strategy for controlling the disease.
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Llorente Barrio M, García López S, Gilaberte Calzada Y, Monzón Báez RM, Casas Deza D, Lamuela Calvo LJ. Bilateral pyoderma gangrenosum associated with ulcerative colitis and restorative proctocolectomy. Gastroenterol Hepatol 2018; 42:441-442. [PMID: 30470567 DOI: 10.1016/j.gastrohep.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/17/2018] [Accepted: 10/07/2018] [Indexed: 11/18/2022]
Affiliation(s)
| | - Santiago García López
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | - Diego Casas Deza
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
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36
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Valejo Coelho MM, Fernandes C. [Pyoderma Gangrenosum in a Patient with Ulcerative Colitis]. ACTA MEDICA PORT 2018; 31:346. [PMID: 30020881 DOI: 10.20344/amp.10641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/16/2018] [Indexed: 11/20/2022]
Affiliation(s)
| | - Cândida Fernandes
- Serviço de Dermatovenereologia. Centro Hospitalar de Lisboa Central. Lisboa. Portugal
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37
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Maverakis E, Ma C, Shinkai K, Fiorentino D, Callen JP, Wollina U, Marzano AV, Wallach D, Kim K, Schadt C, Ormerod A, Fung MA, Steel A, Patel F, Qin R, Craig F, Williams HC, Powell F, Merleev A, Cheng MY. Diagnostic Criteria of Ulcerative Pyoderma Gangrenosum: A Delphi Consensus of International Experts. JAMA Dermatol 2018; 154:461-466. [PMID: 29450466 DOI: 10.1001/jamadermatol.2017.5980] [Citation(s) in RCA: 241] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance Pyoderma gangrenosum is a rare inflammatory skin condition that is difficult to diagnose. Currently, it is a "diagnosis of exclusion," a definition not compatible with clinical decision making or inclusion for clinical trials. Objective To propose and validate diagnostic criteria for ulcerative pyoderma gangrenosum. Evidence Review Diagnostic criteria were created following a Delphi consensus exercise using the RAND/UCLA Appropriateness Method. The criteria were validated against peer-reviewed established cases of pyoderma gangrenosum and mimickers using k-fold cross-validation with methods of multiple imputation. Findings Delphi exercise yielded 1 major criterion-biopsy of ulcer edge demonstrating neutrophilic infiltrate-and 8 minor criteria: (1) exclusion of infection; (2) pathergy; (3) history of inflammatory bowel disease or inflammatory arthritis; (4) history of papule, pustule, or vesicle ulcerating within 4 days of appearing; (5) peripheral erythema, undermining border, and tenderness at ulceration site; (6) multiple ulcerations, at least 1 on an anterior lower leg; (7) cribriform or "wrinkled paper" scar(s) at healed ulcer sites; and (8) decreased ulcer size within 1 month of initiating immunosuppressive medication(s). Receiver operating characteristic analysis revealed that 4 of 8 minor criteria maximized discrimination, yielding sensitivity and specificity of 86% and 90%, respectively. Conclusions and Relevance This Delphi exercise produced 1 major criterion and 8 minor criteria for the diagnosis of ulcerative pyoderma gangrenosum. The criteria may serve as a guideline for clinicians, allowing for fewer misdiagnoses and improved patient selection for clinical trials.
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Affiliation(s)
- Emanual Maverakis
- Department of Dermatology, University of California, Davis, Sacramento
| | - Chelsea Ma
- Department of Dermatology, University of California, Davis, Sacramento
| | - Kanade Shinkai
- Department of Dermatology, University of California, San Francisco
| | - David Fiorentino
- Division of Immunology and Rheumatology, Department of Dermatology, Stanford University, Stanford, California
- Division of Immunology and Rheumatology, Department of Internal Medicine, Stanford University, Stanford, California
| | - Jeffrey P Callen
- Division of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky
- Associate Editor
| | - Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden, Dresden, Germany
| | - Angelo Valerio Marzano
- UOC di Dermatologia, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milano-Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy
| | - Daniel Wallach
- Department of Dermatology, Paris Hospitals, Paris, France
| | - Kyoungmi Kim
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis
| | - Courtney Schadt
- Division of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Anthony Ormerod
- Department of Dermatology, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom
| | - Maxwell A Fung
- Department of Dermatology, University of California, Davis, Sacramento
| | - Andrea Steel
- Department of Dermatology, University of California, Davis, Sacramento
| | - Forum Patel
- Department of Dermatology, University of California, Davis, Sacramento
| | - Rosie Qin
- Department of Dermatology, University of California, Davis, Sacramento
| | - Fiona Craig
- Department of Dermatology, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, King's Meadow Campus, University of Nottingham, United Kingdom
| | - Frank Powell
- Charles Institute of Dermatology, University College, Dublin, Ireland
| | - Alexander Merleev
- Department of Dermatology, University of California, Davis, Sacramento
| | - Michelle Y Cheng
- Department of Dermatology, University of California, Davis, Sacramento
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Drerup C, Wefelmeier L, Goerge T. Wound Healing Disorder Caused by Pyoderma Gangrenosum. Am Surg 2018; 84:e112-e113. [PMID: 30454428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Christian Drerup
- Department of Dermatology, Universitaetsklinikum Muenster, Muenster, Germany
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Abstract
While pyoderma gangrenosum (PG) most commonly affects the skin it can also involve other organs. It rarely affects the eye, orbit, or adnexa. Its early recognition and proper management with prompt initiation of immunosuppressive therapy are essential for the preservation of the eye and, in turn, vision, in these cases. Here, we review the limited literature already published regarding ocular involvement in PG.
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Affiliation(s)
- Elizabeth McElnea
- a Ophthalmology Department Mater Misericordiae University Hospital , Dublin , Ireland
| | - Kirk Stephenson
- a Ophthalmology Department Mater Misericordiae University Hospital , Dublin , Ireland
| | - Tim Fulcher
- a Ophthalmology Department Mater Misericordiae University Hospital , Dublin , Ireland
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40
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Marzano AV, Damiani G, Genovese G, Gattorno M. A dermatologic perspective on autoinflammatory diseases. Clin Exp Rheumatol 2018; 36 Suppl 110:32-38. [PMID: 29742056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/07/2017] [Indexed: 06/08/2023]
Abstract
Autoinflammatory diseases (AIDs) encompass a heterogeneous group of disorders pathogenetically related to an abnormal activation of the innate immunity and clinically characterised by aseptic inflammation in the affected organs in the absence of high titer of circulating autoantibodies or autoreactive T cells. In classic monogenic AIDs, the skin is frequently involved with a wide range of cutaneous lesions. Monogenic AIDs result from different mutations in a single gene, which regulates the innate immunity. These mutations cause an uncontrolled activation of the inflammasome, leading to an overexpression of interleukin (IL)- 1β. IL-1β is the pivotal cytokine which is responsible for the exaggerated production of cytokines and chemokines that induce the recruitment of neutrophils, key cells in autoinflammation. Paradigmatic autoinflammatory forms are the cryopyrin-associated periodic syndromes (CAPS), whose skin involvement consists of urticarial lesions. Similar IL-1β-mediated autoinflammatory pathomechanisms also occur in deficiency of IL-1 receptor antagonist (DIRA) and deficiency of IL-36 receptor antagonist (DITRA), whose cutaneous appearance is characterised by pustular lesions, as well as in pyogenic arthritis, pyoderma gangrenosum and acne (PAPA) syndrome. Pyoderma gangrenosum, which is the cutaneous hallmark of the PAPA syndrome, is a prototypic neutrophil-mediated skin disease, manifesting as single or multiple ulcers with undermined, raised erythematous to violaceous borders. This review is focused on the CAPS, DIRA/DITRA and PAPA syndromes with emphasis on their cutaneous manifestations, as well as their histology and pathophysiology.
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Affiliation(s)
- Angelo Valerio Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
| | - Giovanni Damiani
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Giovanni Genovese
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
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41
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Vacas AS, Bollea-Garlatti ML, Torre AC, Galimberti RL. Bullous pyoderma gangrenosum as a predictor of hematological malignancies. An Bras Dermatol 2018; 93:133-134. [PMID: 29641716 PMCID: PMC5871381 DOI: 10.1590/abd1806-4841.20187031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 03/30/2017] [Indexed: 11/21/2022] Open
Abstract
Pyoderma gangrenosum may precede, coexist or follow diverse systemic diseases. The bullous variety is usually associated with hematologic disorders. From 31 patients with pyoderma gangrenosum diagnosed in our hospital during 10 years, only 2 presented with the bullous type. One patient had previous diagnosis of chronic myeloid leukemia. Both had fast-progressive, painful lesions, and both showed an excellent response to systemic corticosteroids. In less than 3 months the lesions recurred simultaneously with the progression of chronic myeloid leukemia in one patient and with the initial diagnosis of acute myeloid leukemia in the other one. They died in less than four weeks. These findings emphasize the importance of its timely diagnosis. Cutaneous lesions could be the first predictor of an underlying disease.
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Affiliation(s)
- Aldana Soledad Vacas
- Department of Dermatology at Hospital Italiano
de Buenos Aires - Buenos Aires, Argentina
| | | | - Ana Clara Torre
- Department of Dermatology at Hospital Italiano
de Buenos Aires - Buenos Aires, Argentina
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Nanoudis S, Tsona A, Tsachouridou O, Morfesis P, Loli G, Georgiou A, Zebekakis P, Metallidis S. Pyoderma gangrenosum in a patient with chronic granulomatous disease: A case report. Medicine (Baltimore) 2017; 96:e7718. [PMID: 28767612 PMCID: PMC5626166 DOI: 10.1097/md.0000000000007718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/04/2017] [Accepted: 07/06/2017] [Indexed: 12/27/2022] Open
Abstract
RATIONALE The simultaneous occurrence of pyoderma gangrenosum (PG) and chronic granulomatous disease (CGD) is uncommon and few cases have been reported worldwide. PATIENT CONCERNS PG is a rare, chronic, ulcerative, neutrophilic skin disease of unknown etiology that requires immunosuppressive treatment. CGD belongs to Primary Immune Deficiencies in which the main defect lies in an inability of the phagocytic cells to generate superoxide making patients susceptible to serious, potentially life-threatening bacterial and fungal infections. DIAGNOSES In this manuscript, we present a case of ulcerative pyoderma gangrenosum in a 28-year-old man with recent diagnosis of chronic granulomatous disease during hospitalization for resistant pulmonary tuberculosis complicated with Aspergillus infection. INTERVENTIONS Second-line therapy with dapsone and intravenous immunoglobulin was initially administered but eventually corticosteroids were added to treatment because of disease progression and further ulceration. OUTCOMES Patient's ulcers were gradually healed with no side effects. LESSONS Corticosteroids could be used under close monitoring for the treatment of PG in a patient with CGD, despite the increased risk for infections.
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Vaysse-Vic M, Mathieu PA, Charissoux A, Charissoux JL, Marcheix PS. Pyoderma gangrenosum or necrotising fasciitis? Diagnostic and therapeutic wanderings. Orthop Traumatol Surg Res 2017; 103:615-617. [PMID: 28286096 DOI: 10.1016/j.otsr.2017.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 01/10/2017] [Accepted: 01/17/2017] [Indexed: 02/02/2023]
Abstract
A case of post-traumatic lower-limb pyoderma gangrenosum (PG) in a 77-year-old female is reported. The diagnosis of PG is frequently one of exclusion, and it is therefore unsurprising that the condition was initially mistaken for necrotising fasciitis then for necrotising bacterial dermo-hypodermitis. Medical and surgical treatment for those conditions proved ineffective. This fact, together with the atypical presentation, promoted a re-evaluation of the diagnosis. The clinical findings and investigation results converged to suggest PG, and a therapeutic trial was initiated. The good treatment response and negative findings from tests for other conditions established the diagnosis of post-traumatic PG.
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Affiliation(s)
- M Vaysse-Vic
- Service d'orthopédie-traumatologie, hôpital universitaire de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France.
| | - P-A Mathieu
- Service d'orthopédie-traumatologie, hôpital universitaire de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - A Charissoux
- Service d'anatomo-pathologie, hôpital universitaire de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - J-L Charissoux
- Service d'orthopédie-traumatologie, hôpital universitaire de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - P-S Marcheix
- Service d'orthopédie-traumatologie, hôpital universitaire de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
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Agarwal US, Agarwal P, Prakash C, Sharma P. Ulcerative Pyoderma Gangrenosum and Leukocytoclastic Vasculitis in a Hypothyroid Woman: A Case Report. WOUNDS : A COMPENDIUM OF CLINICAL RESEARCH AND PRACTICE 2017; 29:E43-E47. [PMID: 28682293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Skin ulcers, especially of the lower extremities, encompass a myriad of causes that a clinician must analyze. Case Re- port. A 45-year-old hypothyroid woman presented with a 6-year history of recurrent widespread eruptions of rashes and ulcers on her skin. She was diagnosed to have pyoderma gangrenosum and leukocytoclastic vasculitis. She was successfully managed with a novel combination of azathioprine and methotrexate. CONCLUSION Pyoderma gangrenosum is an unusual wounding disease that makes the diagnosis and manage- ment challenging. In addition, occurrence of these 2 distinct entities together and their association with preexisting hypothyroidism is new to the scienti c literature and hence discussed here.
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Affiliation(s)
- Uma Shankar Agarwal
- Department of Dermatology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Puneet Agarwal
- Department of Dermatology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Chaitra Prakash
- Department of Dermatology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Priyanka Sharma
- Department of Dermatology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
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Maranda EL, Sheinin R, Brys A, Rubin B, Lim HW. A case of eosinophilic fasciitis associated with pyoderma gangrenosum. J Eur Acad Dermatol Venereol 2017; 31:e356-e358. [PMID: 28150344 DOI: 10.1111/jdv.14148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- E L Maranda
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - R Sheinin
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - A Brys
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - B Rubin
- Division of Rheumatology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - H W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, 48202, USA
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Abstract
INTRODUCTION Pyoderma gangrenosum (PG) is a neutrophilic dermatosis that may be associated with systemic diseases. The association of PG with lymphoid malignancies has rarely been reported. Extranodal natural killer/T-cell lymphoma (ENKTL) is a rare but aggressive entity with a poor prognosis. Here, we report the case of a patient who had idiopathic PG refractory to systemic steroids and subsequently developed ENKTL. CASE REPORT A 70-year-old man presented with a 2-month history of intermittent fever and multifocal painful papules, plaques, and ulcerations on his extremities. The histological and culture results of the lesions were consistent with those of PG. A thorough work-up was performed and did not demonstrate any underlying systemic diseases including malignancy. The PG lesions were refractory to systemic steroid therapy. An enlarging nodule was observed over his right infraorbital area 4 months after the onset of the skin eruptions. The nodule was later biopsied and diagnosed as ENKTL by using histopathological and immunohistochemical studies. Fludeoxyglucose positron emission tomography/computed tomography revealed multiple intense fludeoxyglucose-avid masses in the bones and lungs, suggesting multiorgan metastases. The patient rejected chemotherapy and died 4 weeks after the diagnosis. CONCLUSION The present case indicates that in any patient with idiopathic PG refractory to conventional therapy, the presence of any underlying disease or malignancy must be thoroughly evaluated. The present case serves as a reminder that when assessing patients with PG, clinicians should increase their awareness regarding the delayed association with malignancy, even in the absence of a concomitant systemic disease at presentation. Furthermore, the prompt evaluation of any suspicious lesions in the context of PG for the possibility of a malignant nature can improve the prognosis, particularly in cases of aggressive malignancy. Understanding the cutaneous spectrum of ENKTL is crucial because of its variable clinical appearance and aggressive nature. Our case demonstrates that PG can be a presenting sign of ENKTL.
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Affiliation(s)
- Ting-Hua Yang
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chung-Hong Hu
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsiou-Hsin Tsai
- Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Correspondence: Hsiou-Hsin Tsai, Department of Dermatology, Taipei Medical University Hospital, Taiwan, No. 252, Wu Hsing Street, Taipei City 110, Taiwan (e-mail: )
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Leitsch S, Koban KC, Pototschnig A, Titze V, Giunta RE. Multimodal Therapy of Ulcers on the Dorsum of the Hand With Exposed Tendons Caused by Pyoderma Gangrenosum. Wounds 2016; 28:E10-E13. [PMID: 26992198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The authors present the case of a 54-year-old man with ulcers on the dorsal hand and forearm with exposed extensor tendons after he received misdiagnoses at 2 other hospitals, leading to deep soft tissue defects from multiple debridements. Due to the complicated nature of the wound, the ulcers did not heal under the systemic medication. After careful debridement, the defect was primarily closed with a collagen-glycosaminoglycan biodegradable matrix (Integra Matrix Wound Dressing, Integra LifeSciences, Plainsboro, NJ) on the dorsal hand and covered with a mesh graft 14 days later. Necrosis and superinfection over the index finger was treated again with systemic antibiotics and an unmeshed skin graft under a vacuum bandage with a mesh wound contact layer (Mepitel, Mölnlycke Health Care, Norcross, GA). The patient was satisfied with the functional and aesthetic outcome 1 month later when wounds were completely healed. The authors conclude that in cases where patients are living with pyoderma gangrenosum, even a challenging and complicated wound can be handled successfully with correct systemic immuno- suppression and appropriate soft tissue coverage.
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Affiliation(s)
- Sebastian Leitsch
- Department for Hand Surgery, Plastic Surgery and Aesthetic Surgery at the Ludwig Maximilian University of Munich, Munich, Germany
| | - Konstantin Christoph Koban
- Department for Hand Surgery, Plastic Surgery and Aesthetic Surgery at the Ludwig Maximilian University of Munich, Munich, Germany
| | - Adrian Pototschnig
- Department for Hand Surgery, Plastic Surgery and Aesthetic Surgery at the Ludwig Maximilian University of Munich, Munich, Germany
| | - Virginia Titze
- Department for Hand Surgery, Plastic Surgery and Aesthetic Surgery at the Ludwig Maximilian University of Munich, Munich, Germany
| | - Riccardo Enzo Giunta
- Department for Hand Surgery, Plastic Surgery and Aesthetic Surgery at the Ludwig Maximilian University of Munich, Munich, Germany
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Groleau PF, Grossberg AL, Gaspari AA. Hidradenitis suppurativa and concomitant pyoderma gangrenosum treated With infliximab. Cutis 2015; 95:337-342. [PMID: 26125210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pyoderma gangrenosum (PG) and hidradenitis suppurativa (HS) are rare chronic inflammatory dermatoses of unknown etiologies that often are refractory to conventional treatments. The therapeutic benefits of tumor necrosis factor a (TNF-α) inhibitors have been reported in patients with refractory PG or HS. The copresentation of these 2 diseases has previously been described in several cases in the literature and may present a therapeutic challenge. We present the case of a 51-year-old man who developed widespread inflammatory ulcers affecting approximately 50% of the body surface area and subsequent chronic debilitation from severe pain. He was ultimately diagnosed with concurrent PG and HS. Both diseases remitted in response to treatment with infliximab, which resulted in complete restoration of skin integrity and resolution of his chronic severe pain.
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Kim RH, Lewin J, Hale CS, Meehan SA, Stein J, Ramachandran S. Vegetative pyoderma gangrenosum. Dermatol Online J 2014; 20:13030/qt6x3826zq. [PMID: 25526339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 06/04/2023] Open
Abstract
Vegetative pyoderma gangrenosum is a rare, superficial variant of pyoderma gangrenosum that is more commonly found on the trunk as single or multiple, non-painful lesions. There is typically no associated underlying systemic disease. Compared to classic pyoderma gangrenosum, vegetative lesions are more likely to heal without the use of systemic glucocorticoids, although up to 39% of patients required a short course of prednisone in a review of 46 cases. Treatments for vegetative pyoderma gangrenosum include topical and intralesional glucocorticoids, minocycline or doxycycline, dapsone, colchicine, and, rarely, alternative steroid-sparing immunosuppressants. We present a case of multiple vegetative pyoderma gangrenosum lesions arising in prior surgical sites in a patient found to have IgA monoclonal gammopathy and abnormal urinary protein electrophoresis.
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Marzano AV, Ceccherini I, Gattorno M, Fanoni D, Caroli F, Rusmini M, Grossi A, De Simone C, Borghi OM, Meroni PL, Crosti C, Cugno M. Association of pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH) shares genetic and cytokine profiles with other autoinflammatory diseases. Medicine (Baltimore) 2014; 93:e187. [PMID: 25501066 PMCID: PMC4602806 DOI: 10.1097/md.0000000000000187] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The association of pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH) has recently been described and suggested to be a new entity within the spectrum of autoinflammatory syndromes, which are characterized by recurrent episodes of sterile inflammation, without circulating autoantibodies and autoreactive T-cells. We conducted an observational study on 5 patients with PASH syndrome, analyzing their clinical features, genetic profile of 10 genes already known to be involved in autoinflammatory diseases (AIDs), and cytokine expression pattern both in lesional skin and serum. In tissue skin samples, the expressions of interleukin (IL)-1β and its receptors I and II were significantly higher in PASH (P = 0.028, 0.047, and 0.050, respectively) than in controls. In PASH patients, chemokines such as IL-8 (P = 0.004), C-X-C motif ligand (CXCL) 1/2/3 (P = 0.028), CXCL 16 (P = 0.008), and regulated on activation, normal T cell expressed and secreted (RANTES) (P = 0.005) were overexpressed. Fas/Fas ligand and cluster of differentiation (CD)40/CD40 ligand systems were also overexpressed (P = 0.016 for Fas, P = 0.006 for Fas ligand, P = 0.005 for CD40, and P = 0.004 for CD40 ligand), contributing to tissue damage and inflammation. In peripheral blood, serum levels of the main proinflammatory cytokines, that is, IL-1β, tumor necrosis factor-α, and IL-17, were within the normal range, suggesting that in PASH syndrome, the inflammatory process is mainly localized into the skin. Four out of our 5 PASH patients presented genetic alterations typical of well-known AIDs, including inflammatory bowel diseases, and the only patient lacking genetic changes had clinically evident Crohn disease. In conclusion, overexpression of cytokines/chemokines and molecules amplifying the inflammatory network, along with the genetic changes, supports the view that PASH syndrome is autoinflammatory in origin.
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Affiliation(s)
- Angelo V Marzano
- From the Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (AVM, DF, CC), Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano; UOC Genetica Medica (IC, FC, MR, AG), Istituto Giannina Gaslini; Pediatria II (MG), Istituto Giannina Gaslini, Genova; Dipartimento di Dermatologia (CDS), Università Cattolica del Sacro Cuore, Roma; Dipartimento di Scienze Cliniche e di Comunità (OMB, PLM), Università degli Studi di Milano, Cattedra di Reumatologia, Istituto G. Pini, Milano; IRCCS Istituto Auxologico Italiano, Milano, Italy (OMB); and Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti (MC), Università degli Studi di Milano, Unità Operativa di Medicina Interna, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
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