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A fifty-three year old woman presented with pyoderma gangrenosum on the right buttock. She had associated intestinal symptoms, but repeated roentgenologic studies revealed no abnormalities. Local treatment with benzoyl peroxide (20 percent) lotion produced clearing of the cutaneous lesion in about six weeks.
Of the many acknowledged systemic complications of inflammatory bowel disease, arthritis, iritis and erythema nodosum are observed most commonly and considered parts of the natural history. Pyoderma gangrenosum is a more ominous, less common but similarly associated complication that classically occurs in the course of ulcerative colitis. Its rarity in Crohn's disease stimulated the following report.
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Recurrent gangrenous leg ulcers were associated with a monoclonal IgGk cryoglobulinaemia, though without overt myeloma. Cryoprecipitation of the serum in vitro gave a reversible gel with microtubular structure, built from the monomer and with a high degree of order. The same structure was found distending the superficial vessels of the ulcer biopsy, as well as extravascularly. There was no vasculitis, and luminal obstruction appeared responsible for the ulceration. Microtubular structures occur in nature among diverse proteins and viruses. The protein studied here is similar to a reported instance of myeloma cryo-IgGk.
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Gonococcal pharyngitis has been correlated with fellatio in both heterosexual females and homosexual males. This report describes another complication of fellatio, group A beta-eaemolytic streptococcal pyroderma on the penis after exposure to a male who probably had pharyngitis. the erythematous, purulent lesions should be cultured. After the organism has been identified, adequate treatment with either a long-acting parenteral penicillin or a 10-day course of oral penicillin is important in order to prevent the possible life-threatening complication of post-streptococcal glomerulonephritis.