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Pyoderma gangrenosum is infrequently encountered by the orthopedic surgeon. The appearance of progressive, painful bullae followed injury and infection in a 56-year-old man. The treatment consisted of a search for an associated underlying systemic disease in concert with high-dose steroids. The etiology is not known.
The case of a 54-year-old woman with Felty's syndrome whose course was complicated by mucocutaneous lesions clinically typical of pyoderma gangrenosum is described. Necrotizing sinusitis and saddle nose deformity were distinctive clinical features. Lymphocytic vasculitis and rheumatoid nodule formation observed within panniculus at the base of a cutaneous lesion and in a nasal mucosal lesion were unexpected histopathologic findings.
Pathohistologic examinations of the peripheral lymph nodes in 14 patients with abscessed acne, chronic infiltrative ulcerous and infiltrative fistulous pyoderma coursing for 1 to 11 years have revealed that chronic pyococcal infection induces manifest atrophic and sclerotic changes in the cortical and medullary layers of the regional lymph nodes and of those distant from foci of involvement; these changes are accompanied by essential impairments of the immunologic, lymphopoietic, and other functions.
Twenty-one dogs with idiopathic superficial recurrent pyoderma were entered into a double-blind, placebo-controlled study to evaluate the efficacy of a commercial staphylococcal bacterin. The study spanned an 18-week period. All dogs were administered sodium oxacillin orally for the initial 6 weeks of the study. Dogs were given the bacterin or placebo SC, twice weekly at 3- or 4-day intervals, beginning at week 0 and continuing for 18 weeks. Dogs given antibiotics plus the bacterin (n = 13) had a significantly (P less than 0.05) better treatment response than those given antibiotic plus placebo.
Pyoderma gangrenosum (PG) is a rare condition remarkable for its association with particular diseases, notably haemopathies and gastrointestinal diseases. As regards haemopathies, the associations most frequently encountered are with myeloid malignancies and monoclonal dysglobulinaemia. The association of PG with mainly inflammatory digestive tract diseases is also classical. The lack of publications concerning gastric atrophy and the dual haematological and gastric pathology which characterizes our case have prompted us to report it. A 60-year-old woman without significant history was admitted for PG on both knees, following vesiculo-bullous lesions. Laboratory examinations detected a normochromic anaemia tending to be macrocytic, a marked inflammatory syndrome and a monoclonal lambda light chain IgA peak at protein immunoelectrophoresis. Bone marrow biopsy, skeletal radiography and a search for Bence-Jones proteinuria were normal or negative. Colonoscopy showed no abnormality, but fibroscopy of the upper digestive tract revealed a severe gastric atrophy en plaques. Serum vitamin B12 level was moderately low, but there was no other sign of pernicious anaemia. After one month treatment with systemic corticosteroids, healing was obtained under replacement vitamin therapy. PG recurred a few months later; serum vitamin B12 level was normal, and the lesions healed after systemic corticosteroid treatment. In non-myelomatous dysglobulinaemia IgA is frequently found and there is no light chain predominance. PG often precedes dysglobulinaemia. Evolution towards a true myeloma seems to be exceptional. In a recent publication, 17 cases of association between PG and myeloma were mentioned, the IgA type being most common. Protein electrophoresis is indispensable in patients with PG. Five cases of congenital hypogammaglobulinaemia have been recorded, including three with IgA deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)
A young woman with ulcerative colitis developed pyoderma gangrenosum during the active phase of the disease and Sweet's syndrome (acute febrile neutrophilic dermatosis) three months after panproctocolectomy.
One hundred and seventy six cases of various clinical types of pyodermas were investigated to find the causative organism of the disease. Folliculitis formed the largest clinical group followed by infectious eczematoid dermatitis, secondary infection, furuncles, impetigo, ecthyma and carbuncle in descending order of frequency. A total of 189 micro-organisms were isolated from the specimens examined. A single infecting organism was isolated from 74.43% and more than one type of organism from 16.48% of cases. Coagulase positive staphylococcus (73.02%) was the predominant species followed by beta-haemolytic streptococcus (26.98%). Coagulase positive staphylococcus was isolated from 109 (61.93%), beta-haemolytic streptococcus from 22 (12.5%) and both these organisms from 29 (16.48%) cases. The antibiotic resistance pattern showed maximum resistance to penicillin followed by ampicillin. None of the strain was found to be resistant to kanamycin. Low percentage of strains were found to be resistant to streptomycin, oxytetracycline, trimethoprim, cloxacillin, erythromycin, chloramphenicol, cephalexin, gentamycin and neomycin.
Pyoderma gangrenosum (PG) is an uncommon ulcerative cutaneous condition with distinctive clinical characteristics and a frequent association with systemic diseases. Most frequently among the associated disease list are: inflammatory bowel disease, arthritis, and a variety of hematologic disorders. There is no specific treatment of PG; however, the effective treatment of an accompanying systemic disease, local therapy, and/or the use of topical or systemic agents known to be useful in neutrophil disorders, have been beneficial in most patients.
Pustulotic arthro-osteitis is a rare syndrome manifested by palmo-plantar pustulosis and abnormalities involving the anterior chest wall, the spine, the sacroiliac and peripheral joints. We present the case of a patient with pustulotic arthro-osteitis who developed pyoderma gangrenosum. We believe this association has not been previously described in the literature.
Pyoderma gangrenosum (PG) has been increasingly reported in association with myeloproliferative disorders. Monoclonal gammaopathy, myeloma, myeloid metaplasia, and polycythemia have all been found in association with PG. Recently, seven cases of PG in association with leukemia have been described: three cases with acute myeloblastic leukemia, two cases with chronic myelogenous leukemia, one case with acute lymphoblastic leukemia, and one case with acute leukemia of either plasma cell or myeloblast origin. To these we add two cases of PG with acute myeloblastic leukemia. These patients often have an atypical clinical presentation for PG, with bullae and relatively superficial involvement obscuring the correct diagnosis.
Clinical and immunologic examinations of 55 patients suffering from ulcerous forms of chronic pyoderma have revealed increased counts of the peripheral blood theophylline-sensitive T-lymphocytes before therapy. A decrease of the level of this subpopulation, mainly responsible for the suppressor-cytotoxic function of T-cells, during combined therapy including prospidin is suggestive of an immunocorrecting effect of this drug.
Thirty-four patients with chronic pyoderma have been examined. Fifteen of these have been treated with mielopid (18 mg per course). Immunologic and clinical examinations carried out in 3-10 months after therapy have demonstrated a wide-spectrum immunostimulating action of the new drug.
A 60-year-old woman had a typical pyoderma gangrenosum with monoclonal IgA gammopathy and atrophic gastritis. Two years after the onset of her skin disease, she had evidence of pulmonary abscesslike involvement. Corticosteroid therapy led to healing of skin and lung diseases. This case stresses the multisystemic manifestations of neutrophilic dermatoses with special attention to pulmonary involvement.
Pyoderma gangrenosum (PG) is a extending necrotic ulceration with bluish and purplish red margins. This disease is often associated with ulcerative colitis, systemic, hematologic or rheumatic affections. However post-surgical idiopathic PG can occur. One post-mammectomy case is reported. PG can first be suspected on clinical aspect, lack of a specific etiology. PG is a diagnosis of exclusion that is made only after others possibilities are ruled out. The treatment is surgical excision and general corticotherapy.
A patient with chancriform pyoderma is described. He has been repeatedly examined with the use of routine serologic tests, Treponema pallidum immobilization and immunofluorescence tests and other laboratory analyses; this has permitted a correct clinical diagnosis. A 6-month follow-up, including clinical examinations and laboratory analyses, has confirmed the diagnosis.
The exact mechanism involved in the pathogenesis of pyoderma gangrenosum (PG) still remains unclear, yet there is an increasing number of reports associating PG with immunologic abnormalities. A correlation between PG and myeloproliferative disorders has also been described. We describe a patient with chronic myelocytic leukemia in whom PG developed during the course of illness. We present an immunologic analysis of this case, speculation on the pathogenesis of PG, and a review of the literature. We report the futility of current therapeutic modalities in the treatment of PG.
This is a report on a patient suffering from a progressive ulcerative tumour of the vault of the cranium with accompanying osteolytic destruction. The disease pattern was interpreted first after a biopsy from the marginal wall of the inflammation as a case of pyoderma. It was only on postmortem examination that an angiosarcoma of the ulcerative type was correctly diagnosed. The ulcerative type of angiosarcoma is sometimes difficult to differentiate from inflammatory skin diseases.
We describe two patients with biopsy-proven pyoderma gangrenosum who developed a peripheral erosive arthritis resembling that seen in psoriatic arthritis. This association is discussed with particular reference to reactive arthritis.