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This is a report of a case with a chronic peculiar intractable pyoderma. The process started a year after splenectomy because of trauma. In the absence of an apparent other reason, we assume that a relationship exists between the operation and the skin disease.
Two cases with pyoderma gangrenosum are presented. The course, in both cases, suggested that immunosuppressive therapy may play an etiological role in the disease. The first was a kidney recipient receiving prednisone and azathioprine and the second, a patient with pemphigus vulgaris who was treated with prednisone and methotrexate.
Patients with extensive lower extremity ulcerations initially thought to be vascular disease were subsequently proved to have pyoderma gangrenosum and malignant lymphoma. Both patients died of sepsis; one patient exhibited hypogammaglobulinemia involving immunoglobulins IgA, IgG, and IgE; in the second patient, a polyclonal excess involving IgA and IgE was present.
A transient neutrophilic chemotactic deficit was confirmed in a 3 1/2-year-old castrated male dog with recurrent staphylococcal pyoderma accompanied by a persistent eosinophilia and intermittent basophilia. Neutrophilic chemotaxis was quantitatively assessed over the next seven months, and the disappearance of the chemotactic deficit correlated with complete clinical remission of the skin lesions. Aberrations of the complement system were not discovered, and the dog's serum showed increased chemoattractiveness for control neutrophil preparations.
A 50-year-old man with a 7-year history of an ulcerative rash on the lower extremities had rapidly progressive renal failure. Monoclonal IgA (lambda) was detected in his serum. Kidney biopsy revealed proliferative glomerulonephritis with dominant IgA and C3 deposition, compatible with IgA nephropathy. Immunohistochemical staining with anti-lambda chain was negative and electron microscopic examination revealed deposits in subendothelial and mesangial areas. The findings on the skin biopsy were consistent with that of a pyoderma gangrenosum. The patient was treated with prednisolone pulse therapy followed by oral prednisolone. Renal function gradually and almost completely improved and proteinuria disappeared.
Previous immunofluorescence studies on pyoderma gangrenosum (PG) proved negative. Biopsies from the ulcer edge of 8 patients with PG were examined by immunofluorescence microscopy. Deposits of complement C3 were seen in the vessel walls of all samples, IgM in three and IgA in one. Granular deposits of C3 were seen at the dermal--epidermal junction in 2 patients. Biopsies from clinically normal skin of 6 of the patients were negative. It is suggested that deposition of immune complexes in the dermal vessel walls may play a role in the pathogenesis of PG.
Primary pyodermas are frequently encountered in primary care practice. Staphylococci and streptococci are the most common causes of infection, although a number of organisms may be found in particular clinical settings. Penicillin, semisynthetic penicillins, and erythromycin are the mainstays of treatment. Even though culture for specific pathogens is performed, treatment is often empirical. Therefore, familiarity with these common lesions and their management aids in efficient and effective treatment.
An 80-year-old Caucasian female with rheumatoid arthritis and recurrent atypical bullous pyoderma gangrenosum is described. There was no evidence of any underlying myeloproliferative disorder. Rapid healing occurred in response to oral minocycline hydrochloride and topical clobetasol propionate.
A case of Pyoderma gangrenosum with two different abdominal sites in a female patient suffering from colonic Crohn's disease is presented. Local trauma on the midline scar of an incisional hernia and around the stoma were the possible triggering factors. Despite the major abdominal wall defect and an infected parietal collection, steroid therapy was very effective without the need for surgery.
We report a 52-year-old male Caucasian who presented with a peripheral erosive arthritis, then pyoderma gangrenosum, and six years later pancolitis and orogenital ulcers. The case illustrates an overlap that may exist between Behçet's syndrome and inflammatory bowel disease. In either condition seronegative erosive peripheral joint disease is an uncommon presenting feature.
Applying standardized and sound operative techniques, impaired wound healing following reduction mammoplasty is rare. A postoperative case of pyoderma gangraenosum is reported. This necrotizing skin disorder seemed at first to be a postoperative bacterial infection, but correct diagnosis was finally made histopathologically. The clinical course, etiology, diagnostic findings, and therapy are discussed and a review of the literature is presented.
We report on the appearance of centrifugally spreading ulcers with undermined borders in two patients with chronic recurrent erythema elevatum diutinum controlled with dapsone. The ulcerated lesions were consistent on clinical and pathologic examination with the diagnosis of pyoderma gangrenosum. They eventually responded to treatment with oral corticosteroids. The addition of cyclosporine was required in one case. No associated disease was found in any of the patients. The possible pathophysiological mechanisms of this uncommon association are reviewed.
Pyoderma gangrenosum (PG) consists of extensive necrotic ulceration with bluish and purplish red margins. This disease is often associated with ulcerative colitis, systemic, hematologic or rheumatic diseases. However post-surgical idiopathic PG can occur. One post-mastectomy case is reported. PG can first be suspected on clinical appearance and the lack of a specific etiology. PG is a diagnosis of exclusion that is made only after other possibilities have been ruled out. The treatment is surgical excision and systemic corticosteroids.
A careful survey of the literature on the relationships between pyoderma gangrenosum and Crohn disease is made. The pathogenetical and clinical aspects are analysed and a case, personally observed, is presented.
A severe case of pyoderma gangrenosum in a Papua New Guinean girl aged 11 years in reported. Multiple lesions of the arms, legs, buttocks and mouth were present. There was no associated disease. She was treated with very high doses of prednisolone and slow resolution over 3 months in hospital was observed.
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.