Pyoderma Vegetans of the Perineum in the Setting of Ulcerative Colitis.

CASE REPORT

A 51-year-old man who had undergone total proctocolectomy with ileoanal anastomosis for ulcerative colitis (UC) 6 years prior presented with extensive nonitchy perianal lesions of 5-month duration (Figure 1). He was undergoing regular follow-up via anoscopy and pouchoscopy with mucosal biopsies to rule out recurrence and pouchitis, respectively; these were negative each time. His stool frequency was 5–7 per day. There was no any other significant medical history, extraintestinal manifestations of UC, and he was not on any other medications that could cause an adverse drug reaction. On examination, there was extensive tender perianal excoriation with erosions and a serosanguinous discharge. A biopsy from the lesion revealed pseudoepitheliomatous hyperplasia, fibrosis, vascular proliferation, neutrophilic infiltration, and eosinophilic microabscesses (Figure 2). Periodic acid–Schiff and lipophosphoglycan stains were negative. Immunohistochemical examination with CD68 stain revealed no granuloma formation. Based on the clinical and histopathological findings, the patient was diagnosed as having pyoderma vegetans (PV). He was started on systemic steroids, amoxicillin clavulanate 1 g twice daily, and topical wound care with zinc oxide dressing. The lesions healed well over 3 weeks.

Figure 1.

Perianal excoriation mimicking eczema.

Figure 2.

Photomicrograph of hematoxylin and eosin stain (20×) showing pseudoepitheliomatous hyperplasia, fibrosis, vascular proliferation, neutrophilic infiltration, and eosinophilic microabscesses.

PV is a rare benign cutaneous, chronic, inflammatory, pustular condition clinically characterized by raised, erythematous, exudative, vegetating plaques. This disease of unknown etiology is often associated with bacterial infections in immunocompromised patients.[1] The association of PV and UC has rarely been reported in the literature.[2] The lesion can heal spontaneously, but usually recurs and becomes chronic. There are no standard treatment modalities. Systemic steroids, oral antibiotics, and local wound care controlled the disease in our patient.[3]

DISCLOSURES

Author contributions: S. Shanavas reviewed the literature and wrote the manuscript. B. Jayasankar reviewed the literature. G. Rodrigues reviewed the literature, revised the manuscript, and is the article guarantor.

Financial disclosures: None to report.

Informed consent was obtained for this case report.