BACKGROUND: Pyoderma gangrenosum (PG) is a rare and difficult-to-diagnose disease that often associates with inflammatory bowel disease. CASE: We present a case of a 57-year-old female with ulcerative colitis receiving 5-ASA who presented with rapidly progressive ulcers in the right foot and on the inside of the thigh, extending from the left large vaginal lip to the perianal area, compatible with PG. She was initially treated with corticosteroids with no response. After multidisciplinary consultation, it was decided to initiate in-fliximab 5 mg/kg, and to perform ileostomy for fecal diversion and negative-pressure wound therapy. The patient presented with marked improvement of the lesions, being discharged after 2 months and demonstrating almost complete resolution of the lesions within 4 months. CONCLUSION: Due to the rarity of PG, there is no evidence of the optimal management. The role of surgery is controversial as PG lesions can demonstrate pathergy and theoretically could worsen with surgical intervention. In this case it was decided based on the extent of the lesions and the experience in other septic/ulcerative perianal conditions.
BACKGROUND: Pyoderma gangrenosum (PG) is a rare and difficult-to-diagnose disease that often associates with inflammatory bowel disease. CASE: We present a case of a 57-year-old female with ulcerative colitis receiving 5-ASA who presented with rapidly progressive ulcers in the right foot and on the inside of the thigh, extending from the left large vaginal lip to the perianal area, compatible with PG. She was initially treated with corticosteroids with no response. After multidisciplinary consultation, it was decided to initiate in-fliximab 5 mg/kg, and to perform ileostomy for fecal diversion and negative-pressure wound therapy. The patient presented with marked improvement of the lesions, being discharged after 2 months and demonstrating almost complete resolution of the lesions within 4 months. CONCLUSION: Due to the rarity of PG, there is no evidence of the optimal management. The role of surgery is controversial as PG lesions can demonstrate pathergy and theoretically could worsen with surgical intervention. In this case it was decided based on the extent of the lesions and the experience in other septic/ulcerative perianal conditions.
Authors: Maria Pichler; Lorenz Larcher; Michael Holzer; Gerald Exler; Tobias Thuile; Barbara Gatscher; Lukas Tappeiner; Jenny Deluca; Cinzia Carriere; Van Anh Nguyen; Verena Moosbrugger-Martinz; Matthias Schmuth; Georg F Klein; Klaus Eisendle Journal: J Am Acad Dermatol Date: 2016-04 Impact factor: 11.527
Authors: M Pichler; T Thuile; B Gatscher; L Tappeiner; J Deluca; L Larcher; M Holzer; V A Nguyen; G Exler; M Schmuth; G F Klein; K Eisendle Journal: J Eur Acad Dermatol Venereol Date: 2016-05-26 Impact factor: 6.166
Authors: Marco Fraccalvieri; Maria Teresa Fierro; Marco Salomone; Paolo Fava; Enrico M Zingarelli; Giovanni Cavaliere; Maria G Bernengo; Stefano Bruschi Journal: Int Wound J Date: 2012-08-14 Impact factor: 3.315
Authors: Emanual Maverakis; Chelsea Ma; Kanade Shinkai; David Fiorentino; Jeffrey P Callen; Uwe Wollina; Angelo Valerio Marzano; Daniel Wallach; Kyoungmi Kim; Courtney Schadt; Anthony Ormerod; Maxwell A Fung; Andrea Steel; Forum Patel; Rosie Qin; Fiona Craig; Hywel C Williams; Frank Powell; Alexander Merleev; Michelle Y Cheng Journal: JAMA Dermatol Date: 2018-04-01 Impact factor: 10.282