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PubMed2006

Pyoderma gangrenosum after caesarean section: a case report.

BACKGROUND: Pyoderma gangrenosum is a rare ulcerative skin disease. The diagnosis is based on clinical features and excluding other causes of skin ulcers, as it does not have characteristic histopathology or laboratory findings. The etiology is poorly understood. Lesions can develop spontaneously, after surgery or after trauma. CASE PRESENTATION: We present the case of a 32-year-old woman with ulcerative wound defect after caesarean section. The wound was not healing despite standard wound care and antibiotic treatment. Pyoderma gangrenosum was diagnosed and after high dose corticosteroids wound healing started. CONCLUSION: Early diagnosis and subsequent treatment of pyoderma gangrenosum are crucial for limiting scar tissue. Diagnosis of pyoderma gangrenosum could easily be missed since gynaecologists are rarely confronted with this disorder.

Journal Article↗

PubMed1992

Infantile pyoderma gangrenosum.

A six month old female infant with pyoderma gangrenosum is reported. Pyoderma gangrenosum in an infant is rare. The child responded to pulse therapy with intravenous dexamethasone and intralesional triamcinolone acetonide.

Dexamethasone↗

PubMedDate not supplied

Ulceration of pyoderma gangrenosum treated with negative pressure wound therapy.

Pyoderma gangrenosum is a skin disease characterized by wounds with blue-to-purple undermined borders surrounding purulent necrotic bases. This article reports on a patient with a circumferential, full-thickness, and partially necrotic lower-extremity ulceration of unknown etiology. Results of laboratory tests and arterial and venous imaging studies were found to be within normal limits. The diagnosis of pyoderma gangrenosum was made on the basis of the histologic appearance of the wound tissue after biopsy as a diagnosis of exclusion. Negative pressure wound therapy was undertaken, which saved the patient's leg from amputation. Although negative pressure wound therapy has demonstrated efficacy in the treatment of chronic wounds in a variety of circumstances, this is the first documented use of this technique to treat an ulceration secondary to pyoderma gangrenosum.

Aged↗

PubMed1990

Pyoderma gangrenosum in childhood leukemia.

A case of pyoderma gangrenosum (PG) in a 14-year-old boy with acute myelogenous leukemia (AML) is described. The onset of pyoderma gangrenosum coincided with the relapse of AML. The lesions responded dramatically to treatment with oral prednisone despite the persistence of leukemia. Pyoderma gangrenosum should be included in the differential diagnosis of any nodular, pustular, or necrotic cutaneous eruption in children with leukemia.

Adolescent↗

PubMed1998

Pyoderma gangrenosum complicating ulcerative colitis: Successful treatment with methylprednisolone pulse therapy and cyclosporine.

A 32-year-old woman with ulcerative colitis had a relapsed of pyoderma gangrenosum during puerperium. Both the pyoderma gangrenosum and ulcerative colitis had been well controlled with oral prednisolone, but ulcerative colitis relapsed in pregnancy, and pyoderma gangrenosum relapsed in the puerperium. The pyoderma gangrenosum responded to methylprednisolone pulse therapy initially, but relapsed when prednisolone was tapered. A second trial of pulse therapy combined with cyclosporine resulted in complete remission of the pyoderma gangrenosum, and no recurrence was recognized after prednisolone was tapered. This is a very rare case of successful treatment with methylprednisolone pulse therapy combined with cyclosporine for pyoderma gangrenosum complicating ulcerative colitis.

Adult↗

PubMed1994

[Ulcerative colitis associated with pyoderma gangrenosum].

The authors present a 42-year-old man's case in whom the onset of chronic ulcerative colitis and pyoderma gangrenosum was simultaneous. Pyoderma gangrenosum began as bullae on his chest and lower limb. The main symptoms were fever, anaemia, hypoproteinaemia beyond the skin lesions, and the abdominal symptoms characterizing chronic ulcerative colitis were absent. The thorough internal check-up and the micribiologic and histologic examinations of the skin disorders made clear that the lesions mentioned were the skin symptoms of a systemic disease. Sulfasalazin and prednisolone therapy of the underlying disease and the local non-specific treatment of the cutaneous lesions resulted together in the patient's rapid improvement. The authors give a brief review of pyoderma gangrenosum and of the connection between pyoderma gangrenosum and chronic ulcerative colitis.

Adult↗

PubMed2001

[Cutaneous pyoderma gangrenosum with hepatosplenic localization and monoclonal gammapathy. A case report].

Pyoderma gangrenosum is an ulcerative disease of the skin. The histopathological lesions are nonspecific, characterized by a diffuse neutrophilic infiltrate in the dermis. Pyoderma gangrenosum is associated with inflammatory, digestive or articular disease, or acute or chronic hemotology disorders in 50% of the cases, more rarely with monoclonal gammapathy. A visceral localization of pyoderma gangrenosum is rare, simulating a systemic disease or an underlying neoplasia. We report a case of cutaneous pyoderma gangrenosum with splenic and hepatic localizatios associated with an IgG monoclonal gammapathy. We emphasize the efficacy of immunosuppressor treatment and the importance of long-term monitoring of these patients.

Drug Monitoring↗

PubMed1994

Treatment of pyoderma gangrenosum with cultured keratinocyte autografts.

BACKGROUND: Pyoderma gangrenosum is an uncommon chronic skin disease characterized by rapidly enlarging cutaneous ulcers. Immunosuppressive agents, such as corticosteroids, are the mainstay of therapy. OBJECTIVE: We describe a patient with pyoderma gangrenosum treated with cultured keratinocyte autografts for a full-thickness ulcer located on the dorsal and lateral aspects of the foot. METHODS: After stabilizing the ulcer with intralesional and systemic corticosteroids, the ulcer was debrided and cultured keratinocyte autografts were secured with nylon mesh. An outer dressing of gauze and elastic bandage was used. RESULTS: The patient had > 95% "take" of the grafts and the ulcer was fully healed in less than 1 month. The grafted area preserved the clinical phenotype of the palmar skin from which the original biopsy was taken. CONCLUSION: Cultured keratinocyte autografts can provide permanent wound coverage for patients on high doses of immunosuppressive medications.

Administration, Oral↗

PubMed1997

Intravenous cyclosporine therapy in the treatment of pyoderma gangrenosum secondary to Crohn's disease.

Pyoderma gangrenosum is a destructive, ulcerative skin condition often associated with systemic illnesses such as inflammatory bowel disease, myeloproliferative disorders, and the inflammatory arthritides. We present a patient with long-standing pyoderma gangrenosum associated with Crohn's disease. Multiple deep leg ulcerations were unresponsive over the course of several years to treatment with azathioprine, systemic corticosteroids, 6-mercaptopurine, and dapsone. The patient was hospitalized and treated with a ten-day course of intravenous cyclosporine therapy followed by outpatient oral cyclosporine and showed significant improvement.

Adult↗

PubMed1996

Pyoderma gangrenosum severely affecting both hands.

We report a case of pyoderma gangrenosum affecting both hands simultaneously. Pyoderma gangrenosum affecting the hands is an extremely rare condition which may result in considerable tissue destruction. Management includes immunosuppressant therapy, treatment of associated medical conditions and minimal surgical intervention. Despite a high maintenance dose of corticosteroid and adequate control of coexisting ulcerative colitis and rheumatoid arthritis, tissue destruction in the hands spread rapidly in our patient. The key to the patient's dramatic improvement was the tissue biopsy suggesting pyoderma gangrenosum and the subsequent treatment with the cytotoxic immunosuppressant, azathioprine.

Amputation, Surgical↗

PubMed2005

Management of peristomal pyoderma gangrenosum.

PURPOSE: This study was designed to evaluate the presentation, management, and outcome of peristomal pyoderma gangrenosum at a specialist colorectal unit and develop a strategy for therapy. METHODS: Patients with peristomal pyoderma gangrenosum were identified from a prospectively accrued Institutional Review Board-approved stoma database. Data were collected regarding demographics, disease status, history of illness, time to healing, and treatments used from the database and by chart review. RESULTS: Sixteen patients presented between 1997 and 2002 with peristomal ulceration consistent with a diagnosis of peristomal pyoderma gangrenosum. Diagnosis was predominantly clinically based on a classic presentation of painful, undermined peristomal ulceration. The underlying diagnosis was Crohn's disease in 11 patients, ulcerative colitis in 3, indeterminate colitis in 1, and posterior urethral valves in 1. At the time of development of peristomal pyoderma gangrenosum, the underlying disease was active in 69 percent of patients. Stoma care, ulcer debridement with unroofing of undermined edges, and intralesional corticosteroid injection was associated with a 40 percent complete response rate and further 40 percent partial response rate. Of five patients who received infliximab, four (80 percent) responded to therapy. Complete response after all forms of therapy, including stoma relocation in seven patients, was 87 percent. CONCLUSIONS: Local wound management and enterostomal therapy are extremely important for patients with peristomal pyoderma gangrenosum. Infliximab may provide a useful option for those failing other forms of medical therapy. Relocation of the stoma is reserved for persistent ulceration failing other therapies, because peristomal pyoderma gangrenosum may recur at the new stoma site.

Adrenal Cortex Hormones↗

PubMed2000

Pyoderma gangrenosum as an early revelator of acute leukemia.

Bullous pyoderma gangrenosum is an atypical, more superficial variety of the classical pyoderma and is often associated with myeloproliferative disorders. We present the case of a patient who presented initially with subcutaneous nodules and who developed bullous lesions afterwards. Histological evaluation showed the presence of neutrophilic infiltrates in both lesions. A few months after the diagnosis of bullous pyoderma gangrenosum, an underlying leukemia was revealed. Our case illustrates the importance of regular blood and bone marrow examinations in patients with atypical bullous pyoderma gangrenosum, resulting in a rapid diagnosis of the underlying disease.

Female↗

PubMed2001

Understanding pyoderma gangrenosum: a review.

CONTEXT: Diagnosis and management of pyoderma gangrenosum, a chronic, ulcerative cutaneous inflammatory disease often associated with systemic disease, requires a multidisciplinary approach. No large-scale, controlled trials have been conducted and, as a consequence, the knowledge of this condition is largely based on anecdotal reports. OBJECTIVE: To investigate current understanding of the diagnosis and management of pyoderma gangrenosum. DESIGN: Critical review article. Two hundred eighty-six articles, limited to articles in English and pertaining to humans, were retrieved and reviewed from a MEDLINE search spanning the years 1960-2000. CONCLUSIONS: Diagnosis of pyoderma gangrenosum often requires consultation by multiple specialists in different fields of medicine. Treatment is individually tailored and depends on disease severity and the presence of associated disease. Local treatment is sufficient for mild disease, and the use of immunosuppressive agents is reserved for severe or refractory cases, with cyclosporin being the agent of choice. The long-term outcome for these patients has not been established.

Humans↗

PubMed1988

Pyoderma gangrenosum as a manifestation of leukemia in childhood.

Pyoderma gangrenosum is an uncommon skin lesion often associated with autoimmune diseases. A clear association between leukemia and pyoderma gangrenosum in adults has been established. Two cases of pyoderma gangrenosum in children with leukemia in whom it may be an initial finding are presented.

Adolescent↗

PubMed2002

Ocular and extracutaneous involvement in pyoderma gangrenosum.

PURPOSE: To report an unusual presentation of pyoderma gangrenosum with ocular and extracutaneous involvement. DESIGN: A single, interventional case report. METHODS: A 28-year-old female presented with nodular scleritis in the right eye and left orbital inflammation lasting 1 year. The patient initially responded to systemic steroids, but then ocular inflammation became more severe, associated with onset of fever, myalgias, and elevation of the erythrocyte sedimentation rate, accompanied by formation of multiple cutaneous abscesses. MAIN OUTCOME MEASURES: Ocular and systemic disease control. RESULTS: The diagnosis of pyoderma gangrenosum was made 1 year after the occurrence of ocular symptomatology, when the patient presented with ocular and skin lesions and abscesses in the spleen and liver. CONCLUSIONS: Pyoderma gangrenosum is a rare, necrotizing, noninfectious ulcerating skin disease. Ocular and extracutaneous involvement rarely occur, but the disease should be included in the differential diagnosis of scleritis and orbital inflammation.

Abscess↗

PubMed2005

Pyoderma gangrenosum coexisting with acute myelogenous leukaemia.

The frequency of occurrence of malignant neoplasms in the cases of pyoderma gangrenosum is not exactly determined, but it can be assessed to be at 7%. The aim of the study was to report a 26-year-old male patient with pyoderma gangrenosum coexisting with acute myelogenous leukaemia. The first skin lesions on both tibia occurred in June 2001. Prior to the proper diagnosis of pyoderma gangrenosum, the patient was treated surgically. Because of the dramatic dermatological and general condition in November 2001, the patient was admitted to the Dermatological Department of the Silesian Medical Academy in Katowice where the diagnosis of pyoderma gangrenosum was established. On the clinical and biochemical picture, the diagnosis of pyoderma gangrenosum within acute myelogenous leukaemia was made. Initially, cyclosporin A 200 mg orally per day in the therapy of pyoderma gangrenosum was administered to achieve a slight clinical improvement. Although chemotherapy leukaemia was performed, the patient died after 4 months of the confirmation of the acute myelogenous leukaemia diagnosis.

Adult↗

PubMed2006

Bullous pyoderma gangrenosum as the presenting sign of fatal acute myelogenous leukemia.

Bullous pyoderma gangrenosum begins as a bulla, nodule or nonulcerated erythematous plaque that blisters or ulcerates to form a superficial ulcer surrounded by a hemorrhagic, bullous border, which is surrounded by a blue-gray halo. Bullous pyoderma gangrenosum is most commonly associated with hematologic malignancies, specifically, acute myelogenous leukemia (AML). We report a patient whose initial presentation with bullous pyoderma gangrenosum prompted the appropriate diagnostic evaluation and confirmation of AML, which was ultimately fatal. We emphasize that a thorough hematologic investigation, including bone marrow biopsy, should be performed in all patients who present with lesions clinically suggestive of bullous pyoderma gangrenosum because the skin lesion may be the only indicator of the underlying hematologic disorder.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2005

Erythema nodosum and pyoderma gangrenosum in 50 patients with Crohn's disease.

Erythema nodosum and pyoderma gangrenosum may occur in Crohn's disease. In the present evaluation of consecutive patients with Crohn's disease spanning more than two decades, erythema nodosum was seen in 45 patients and pyoderma gangrenosum was seen in seven patients. Forty-one of 566 women (7.2%) and nine of 449 men (2.0%) were affected. Of these, 45 (4.4%) had erythema nodosum and seven (0.7%) had pyoderma gangrenosum, including two (0.2%) with both dermatological disorders at different times during their clinical courses. Recurrent erythema nodosum was also detected in nine patients (20%) including eight women, while recurrent pyoderma gangrenosum was seen in two patients (28.6%). There was an age-dependent effect on the appearance of erythema nodosum in women, with the highest percentages seen in those younger than 20 years of age. Detection rates for erythema nodosum in women only approached the low men's rates in Crohn's disease at older than 40 years of age. Most patients with these dermatological disorders had colonic disease with or without ileal involvement as well as complex disease, usually with penetrating complications. The present study documents a sex-based and age-dependent effect on the clinical expression of erythema nodosum in Crohn's disease. This suggests that some components of the inflammatory process in Crohn's disease may be modulated by estrogen-mediated events, particularly in adolescents and young adults.

Adult↗