A Rare Case of Recurrent Pyoderma Gangrenosum

Abstract

Introduction: Pyoderma gangrenosum (PG) is a rare non-infectious disorder, and presents as solitary or multiple, fragile papules that progresses to ulcer and necrotic tissue. Autoimmune is the favored pathophysiology associated with this chronic inflammatory skin disease. Systemic disease such as inflammatory bowel disease, rheumatoid arthritis, and haematological disorders often accompany PG. We report a case of recurred PG in 60 year old male with no evidence of associated systemic condition. Case Presentation: A 60 year-old male complained of 1 month-long painful ulceration on his left chest. The lesion started as a pustule which gradually increased in size and broke into painful ulcer. The patient had similar skin lesion, five and three years prior to this admission on the lower abdomen and lower limbs respectively. Both episodes healed more than a year. The diagnosis of ulcerative PG was established based on the physical and histopathological examination. The patient was treated with prednisone and moist wound care. The ulceration responded rapidly. Discussion: Pyoderma gangrenosum is associated with underlying disease in up to two-thirds of case. It occurs typically in adults between 40 and 60 years of age. Although PG predilection is typically lower extremities, any body site can be affected, especially following a trauma. Our patient presented with recurred PG but showed no other systemic condition. Autoinflammatory disease are clinically characterized by recurrent episode and the treatment is quite challenging for its tendency to become chronic, relapsing, or reversible ulcer. Conclusion. We report a rare case of recurred ulcerative PG with no symptom of associated systemic disease who responded rapidly with oral steroid treatment and moist wound care. Keywords: Pyoderma gangrenosum, ulcerative, autoimmune, case report, steroid.