Pyoderma gangrenosum is a rare inflammatory neutrophilic dermatosis, which causes ulceration of the skin. The condition is commonly associated with underlying systemic disorders such as inflammatory bowel disease, arthritis, and hematological disorders. Herein, we describe the case of a familiar association between pyoderma gangrenosum and ulcerative colitis complicated by the newly COVID-19 infection. It is of particular clinical interest to address pyoderma gangrenosum lesions with concurrent treatment of associated disorders that may have influence on the course of the ulcer. Moreover, the therapy should cover as many diseases as possible while not being excessive to minimize possible side effects. Thus, the selection of treatment that spans mutual pathophysiological features of all comorbidities represents the best option to make when handling pyoderma gangrenosum patients. We present a case of the development of gangrenous pyoderma against the background of ulcerative colitis complicated by the new coronavirus infection COVID-19, which will raise awareness of gangrenous pyoderma as a relatively rare cause of ulcerative necrotic skin lesions, which can easily be confused with an infectious process. Of particular clinical importance in the conditions of the COVID-19 pandemic is the correct treatment of gangrenous pyoderma. Only an integrated approach can give a positive result from the therapy.

Pyoderma gangrenosum is an autoinflammatory neutrophilic dermatosis. Diagnosis of the disease remains a difficult task to date, due to the lack of a gold standard of examination and differential diagnostic signs. The primary elements in the development of PG may be papules, pustules or bullae the dissection of which subsequently leads to the formation of ulcers with irregular, violaceous, undermined borders. In rare cases, the diagnosis of the disease can also be complicated by the rapid development of internal organs damage symptoms, which must be regarded as extracutaneous manifestations of PG. Extracutaneous lesions can occur before, during or after the appearance of skin rashes, and the detection of sterile neutrophil infiltrates in the defeat of internal organs confirm the concept of PG as a multisystemic disease. The presented case of a rare course of PG with multiple skin lesions and extracutaneous manifestations, simulating systemic vasculitis, emphasizes the importance of a detailed examination of patients in order to make a correct diagnosis and prescribe timely adequate treatment.

BACKGROUND: Pyoderma gangrenosum is a rare inflammatory skin disease that currently belongs to the group of neutrophilic dermatoses. AIMS: Development of epidemiological, clinical, laboratory characteristics of patients with pyoderma gangrenosum, as well as the treatment of this disease. MATERIALS AND METHODS: The study revealed 30 patients, 16 (53%) were women, the average age at the time of diagnosis was 5916.3 years. The most common localization of rashes was the lower leg 20 patients (67%), lesions of the skin of the face, genitals, and breast rarely noted, in one case, respectively. In 14 patients (47%), two or more ulcers were detected at the same time (max. 9 ulcers). The pathergy phenomenon was positive in 23 patients (77%) of 30. Ulcerative pyoderma gangrenosum occurred in 25 (83%), and extracutaneous pyoderma gangrenosum with lung involvement was identified in one patient. The most common associated disease was rheumatoid arthritis in 6 patients (20%), there were also rare associated diseases, such as hepatitis C two cases, multiple endocrine neoplasia syndrome type 1, autoimmune hepatitis, non-Hodgkins lymphoma by one observation. Histological examination revealed neutrophilic infiltration of the dermis in 30 patients (100%), and the presence of leukocytoclastic vasculitis in 16 (53%). Complete scarring during the treatment was observed in 22 patients (73%). Relapses during the observation period were observed in 12 patients (40%), the number of deaths was two cases. CONCLUSIONS: One of the largest case series of pyoderma gangrenosum to date is presented. During the examination of patients, it was found that neutrophilic infiltration of the dermis is a characteristic sign of the disease. Rare comorbidities (multiple endocrine neoplasia syndrome type 1, autoimmune hepatitis, hepatitis C, non-Hodgkins lymphoma) have been found. A sufficiently large percentage of relapses indicates the need for further research to develop an additional examination method for the purpose of modern diagnostics and justification for the timely prescription of targeted therapy.

No abstract

Patient K., 44 years old, has been ill since November 2018, when for the first time, for no apparent reason, noted the appearance of a painful pustule in the anterior surface of the left leg. After spontaneous opening of the element, an ulcer was formed, characterized by rapid growth (in 14 days up to 8-9 cm in diameter). I turned to a dermatologist, after consultation, treatment was carried out (prednisolone 30 mg per day, antibacterial drugs, vascular therapy, non-steroidal anti-inflammatory drugs) with a positive effect in the form of a gradual, complete scarring of the ulcer.