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PubMedDate not supplied

Acute pyoderma gangrenosum does not require surgical therapy.

Pyoderma gangrenosum is an uncommon ulcerative skin disorder that is often associated with underlying systemic diseases, the most common of which is inflammatory bowel disease. We report an illustrative case of a 36-year-old woman with pyoderma gangrenosum occurring at surgical sites and at sites of trauma. She had associated Crohn disease. Multiple surgical procedures were performed on this patient, without improvement. Pyoderma gangrenosum can mimic a necrotizing soft tissue infection. Early recognition of the characteristic lesion may prevent unnecessary operations and facilitate effective control with appropriate medical therapy.

Acute Disease↗

PubMed1991

Sporotrichosis presenting as pyoderma gangrenosum.

A 56-year-old female with an eight-year history of corticosteroid therapy for rheumatoid arthritis presented with large, deep, painful ulcers on the left buttock and thigh. The lesions appeared typical of pyoderma gangrenosum. Nine separate cultures of the exudate grew Sporothrix schenckii. During the course of iodide therapy, the patient expired due to Escherichia coli pneumonia. This is the third case report of sporotrichosis presenting as pyoderma gangrenosum and the first report from China. Sporotrichosis presenting as pyoderma gangrenosum is a special form of this disease. It develops quickly and must be treated promptly. Only two cases have been reported in the world literature. This is the first case reported from China.

Biopsy↗

PubMed1988

Pyoderma gangrenosum in acute myeloid leukaemia during immunosuppression.

We describe a patient who developed pyoderma gangrenosum during the remission phase of acute myeloid leukaemia whilst receiving maintenance therapy with methotrexate and 6-mercaptopurine. The spontaneous resolution of these skin lesions following discontinuation of chemotherapy suggests that these drugs may be of major significance in the aetiology of pyoderma gangrenosum. Nevertheless, 27 months later, a relapse of the leukaemia followed. Although pyoderma gangrenosum occurred during clinical remission, we cannot rule out a synergism of leukaemia and chemotherapy in its pathogenesis.

Adult↗

PubMed2001

[Pyoderma gangrenosum after TAPP hernioplasty. A rare differential necrotizing wound infection diagnosis].

Pyoderma gangrenosum is an aseptic skin disease that occasionally complicates operative incisions and mimics postoperative necrotising wound infection. So far there are only a few case reports about bacterial necrotising infections following laparoscopy; no report exists about postoperative pyoderma gangrenosum after minimally invasive surgery. Differential diagnosis of both these diseases with potentially high morbidity and mortality is, however, essential, as they require opposite therapeutic regimens. Here we present the case of a patient who developed pyoderma gangrenosum after laparoscopic hernioplasty. Pathophysiological, clinical and therapeutic aspects of the disease are discussed.

Aged↗

PubMed1995

[Pyoderma gangrenosum as a precursor of myeloid leukemia].

A 34-year-old woman who was 20 weeks pregnant developed pyoderma gangrenosum while receiving treatment for infarct pneumonia. Because of her septic condition an abortion was performed. The patient received intravenous prednisolone as a pulse treatment for her pyoderma gangrenosum, which was followed by oral methylprednisolone and oral dapsone for 6 weeks. After dose reduction the patient had a severe relapse. The steroid dose was increased and dapsone was replaced by cyclosporin A. The smaller ulcers healed spontaneously, but skin grafting had to be performed for the large ulcer. The steroid therapy was tapered and discontinued. Cyclosporin A was continued for 10 weeks as monotherapy. Subsequently, the patient was free of symptoms for 7 months. Twelve months after the diagnosis of pyoderma gangrenosum the patient developed acute myeloid leukaemia accompanied by a recurrence of the skin disease.

Adult↗

PubMed1999

[Post-traumatic pyoderma gangrenosum: combination therapy with intravenous immunoglobulins and systemic corticosteroids].

Pyoderma gangraenosum is a rare, chronic type of skin ulceration of unknown aetiology. It occasionally appears following trauma. There are no set standards for the treatment of pyoderma gangraenosum. It is essential to consider acuteness of progression as well as underlying systemic diseases and possible drug side effects before initiating a therapy. Immunosuppressive as well as immunomodulating agents are most often used with varying degrees of success. We report a 45-year-old patient who suffered from an extensive posttraumatic pyoderma gangraenosum after cardiac bypass operation. With short-term combination therapy consisting of high dose intravenous immunoglobulins and systemic corticosteroids, the progression of the disease could be stopped within a few days.

Anti-Inflammatory Agents↗

PubMed2000

[Presentation of pyoderma gangraenosum in a dermatologic atlas of the early 19th century].

Pyoderma gangrenosum was first described in 1930 by Brunsting, Goeckermann and O'Leary. Nevertheless we found some illustrations in an atlas on dermatology, published by Marie-Nicolas Devergie in the first half of the 19th century, which appear to be pyoderma gangrenosum. In addition to discussions of typical syphilitic affections of the skin, Devergie's "Clinique de la Maladie Syphilitique" includes illustrations of gangrenous ulcers, which appeared unexpectedly after local and systemic therapy with mercury. Devergie interpreted those enlarging ulcers as a side effect of mercury therapy. Thus we were able to find evidence of pyoderma gangrenosum more than 100 years before first description in 1930. The etiology of this clinical picture is still unsettled. The favorite postulate has been a bacterial genesis which was the subject of numerous publications until the 1960s.

Atlases as Topic↗

PubMed2003

When is recalcitrant pyoderma gangrenosum truly recalcitrant?

BACKGROUND: The literature supports many different therapies used in recalcitrant pyoderma gangrenosum, which suggests that the pathophysiology is not yet understood. Our hypothesis is that certain patient demographic factors, including age or size of ulcer at presentation, may predict a poor clinical outcome. OBJECTIVE: The goal of our study was to stimulate an analysis of pyoderma gangrenosum treatment failures to identify predisposing conditions that would increase the likelihood of failure. CONCLUSION: Patients older than 50 years of age or with an ulcer greater than 25 cm in diameter may have a poor outcome, but a systematic review of pyoderma gangrenosum treatment failures should be undertaken to support this hypothesis.

Aged↗

PubMed1987

Pyoderma gangrenosum occurring at multiple surgical incision sites.

Ten weeks after subtotal colectomy and ileostomy for ulcerative colitis, a 16-yr-old girl developed wound drainage and back pain. Massive ulceration and skin separation occurred at the abdominal wound incision as well as at the incision sites of a previous central venous line. A diagnosis of pyoderma gangrenosum was made. High-dose steroid treatment induced prompt healing of the abdominal wound as well as the catheter sites. Pyoderma gangrenosum has rarely been seen in surgical wounds. To our knowledge, this is the first reported case of pyoderma gangrenosum occurring simultaneously in multiple surgical incision sites in a patient with ulcerative colitis.

Adolescent↗

PubMed1991

Vulvar pyoderma gangrenosum.

Pyoderma gangrenosum is an idiopathic dermatologic disease manifested by painful cutaneous ulceration. The ulcers are characterized by their undermined, violaceous borders and necrotic tissue at the ulcer base. The lesions may have an unusual response to physical manipulation known as pathergy, a phenomenon that is manifested by rapid progression following debridement. Pyoderma gangrenosum is frequently associated with systemic diseases such as inflammatory bowel disease, rheumatoid arthritis, chronic active hepatitis and hematologic malignancies. Conservative wound care and systemic corticosteroids are usually effective therapy. We report the second case in the gynecologic literature of a patient with vulvar pyoderma gangrenosum.

Adult↗

PubMed1994

An immunopathological study of deep pyoderma in the dog.

The numbers of T lymphocytes (expressing the CD3 marker) and B lymphocytes/plasma cells (expressing IgG, IgM or IgA) in normal canine skin and infiltrating the lesions of deep pyoderma in seven German shepherd dogs and four dogs of other breeds are compared. All dogs with deep pyoderma had similar numbers of IgG, IgM and IgA bearing B lymphocytes/plasma cells but there was a marked paucity of T lymphocytes within the affected skin of German shepherd dogs when compared with that of dogs from other breeds. This suggests a role for T cell dysfunction in the pathogenesis of deep pyoderma in the German shepherd dog.

Animals↗

PubMed1983

Lymphocyte transformation suppression caused by pyoderma--failure to demonstrate it in uncomplicated demodectic mange.

Three dogs with demodectic mange uncomplicated by a bacterial infection and 9 dogs with demodectic mange and pyoderma were tested for their lymphocyte response to phytomitogens in vitro and for the presence of the serum's lymphocyte immunoregulatory factors (SLIF) suppressing blastogenesis. None of the 3 dogs with uncomplicated demodectic mange showed any detectable dysfunction of their lymphocytes or presence of the blastogenesis suppressing SLIF. Their lymphocytes generally responded to the mitogens with more blastogenesis than lymphocytes from healthy controls. On the other hand, in the group of 9 dogs with demodicosis complicated by a bacterial infection, high levels of the blastogenesis suppressing SLIF for concanavalin A-sensitive cells were detected in 4 dogs, for phytohemagglutinin-sensitive cells in 2 dogs, and for pokeweed mitogen-sensitive cells in 1 (of only 3 tested) dog. Dysfunction of lymphocytes per se (detected by a decreased blastogenesis in nonsuppressive normal canine and bovine sera) was detected in 3 dogs with demodicosis with pyoderma. The success of the treatment of demodectic mange or the bacterial skin infection did not correlate with the previous presence or absence of the blastogenesis suppressing SLIF. The treatment of pyoderma was less successful in dogs with an increase in blastogenesis of unstimulated cells in fresh normal canine serum over that in autologous serum. All 3 dogs with a detected dysfunction of their lymphocytes either died or were euthanatized as untreatable cases. It is concluded that the development of demodectic mange per se did not cause the appearance of the blastogenesis suppressing SLIF, which was primarily related to the appearance and extent of the secondary bacterial skin infection.

Animals↗

PubMed1991

Treatment of pyoderma gangrenosum with cyclosporine: results in seven patients.

The mainstay of therapy for pyoderma gangrenosum has been corticosteroids, but many patients respond poorly. During the past 2 years we have treated seven patients who had pyoderma gangrenosum with cyclosporine after their condition proved resistant to conventional therapy. No evidence of permanent toxicity from cyclosporine was detected and treatment with other immunosuppressive agents was discontinued in five of seven cases. Tuberculosis was reactivated in one patient. Three patients had a remission, three had an intermediate response, and one did not respond. These results indicate that cyclosporine is useful in the treatment of patients with refractory pyoderma gangrenosum and suggest an immune mechanism in the pathogenesis of this disorder.

Adult↗

PubMed1992

Peristomal pyoderma gangrenosum.

A patient with Crohn's disease and peristomal pyoderma gangrenosum is described. This patient is unique because she had a rapid response to intralesionally injected steroids. This treatment is ideal for peristomal pyoderma gangrenosum because it is administered intermittently when the ostomy appliance is changed and it does not interfere with adhesion of the device. All 11 cases of peristomal pyoderma gangrenosum described in the literature are reviewed.

Abdominal Muscles↗

PubMed1993

Bullous pyoderma gangrenosum.

Pyoderma gangrenosum is a necrotizing, ulcerative process commonly associated with inflammatory bowel disease but also occurring in several other systemic illnesses. When associated with myelodysplastic syndromes, its clinical appearance is often atypical. We describe a patient with severe, refractory bullous pyoderma gangrenosum. At autopsy cardiac involvement was demonstrated, a finding not previously reported. Patients with this unusual variant of pyoderma gangrenosum have a grave prognosis.

Female↗

PubMedDate not supplied

Pyoderma gangrenosum: uncommon presentations.

Pyoderma gangrenosum (PG) is a rare, inflammatory, noninfective, nonneoplastic skin disorder, which is often associated with systemic diseases. These include inflammatory bowel disease, rheumatoid arthritis, paraproteinaemia, or hematologic malignancy, which can be found in up to 50% of patients with some variants of PG. Brunsting et al (Arch Dermatol 1930;22:655-80) first described PG as a disease entity in 5 patients who had painful, enlarging necrotic ulcers with bluish undermined borders surrounded by advancing zones of erythema. Four of these patients had chronic ulcerative colitis. They felt that the condition might be associated with bacterial infection (pyoderma) and considered it as linked to the underlying bowel disease. Although the cause of PG remains obscure, bacterial infection seems to be unrelated to its causation, rendering the term pyoderma redundant. In addition, the number of conditions reported in association with PG has markedly expanded in recent years, showing clearly that this is not solely a cutaneous manifestation of inflammatory bowel disease. The clinical concept of PG has also been broadened, and certain clinical variants of PG have been linked with different types of associated disease seen in these patients.

Adult↗

PubMed2006

Prostatic infarction involving the urinary sphincter, an association with pyoderma gangrenosum.

A 70-year-old man presented with haematuria and restrictive urinary symptoms 7 years after a transurethral prostatectomy (TURP). Onset of symptoms coincided with development of a large skin ulcer on his back. A diagnosis of pyoderma gangrenosum was made based on clinical signs and histopathology. On repeated cystoscopy the urethral sphincter was obliterated by necrotic tissue, suspicious for malignancy. Histopathology revealed only necrotic tissue consistent with infarction of the prostate and sphincter. This clinical presentation with infarction of the prostate and sphincter, concurrent with development of skin ulcers, was consistent with pyoderma gangrenosum affecting the prostatic urothelium and sphincter. Previous prostatic surgery may have predisposed our patient to development of pyoderma gangrenosum in the area of the prostate.

Aged↗

PubMed1990

Pyoderma gangrenosum in pediatric acquired immunodeficiency syndrome.

We describe two children with human immunodeficiency virus infection in whom pyoderma gangrenosum developed. Although pyoderma gangrenosum most commonly occurs in children with inflammatory bowel disease, it has also been described in patients with a variety of immunodeficiencies. In such patients a vigorous search to exclude a treatable infection should be made before the lesions are treated as pyoderma gangrenosum.

Acquired Immunodeficiency Syndrome↗