Granulomatosis with polyangiitis mimicking classic inflammatory bowel disease-associated pyoderma gangrenosum

Kindle, Scott A.; Camilleri, Michael; Gibson, Lawrence E.; Davis, Mark D.P.

doi:10.1111/ijd.13218

Cited by 11 publications

(8 citation statements)

References 20 publications

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“…Ulcerative PG typically occurs on lower extremities, therefore, an unusual location of PG‐like ulceration, particularly on the head and neck area or upper extremities, should raise suspicion for alternative diagnosis and prompt ANCA testing 4 . Distinction between PG and PG‐like ulcers of AAV should rely on correlation of histopathological features, laboratory testing, and systemic organ involvement as summarized in Table 2.…”

Section: Reportmentioning

confidence: 99%

“…Atypical location of ulcers resembling PG, such as the face or upper trunk, associated clinical findings of purpura, either around the ulcer or of the skin elsewhere, unusual histopathological findings such as vasculitis or granulomatous inflammation with palisaded pattern, should all prompt the clinician to request ANCA testing. There is still a small number of patients where the diagnosis remains in doubt for some time but longitudinal follow‐up will most likely sort out this diagnostic dilemma 3,4 …”

Section: Reportmentioning

confidence: 99%

“…1 Palpable purpura with leucocytoclastic vasculitis (LCV) are the most common manifestations of AAV; however, although less common, ulceration of the skin with features akin to pyoderma gangrenosum (PG) can also be seen, particularly in granulomatosis with polyangiitis (GPA). 2,3 Several case reports have described PG-like ulceration in association with AAV, 4,5 but its true incidence is unknown. In addition, PG is frequently misdiagnosed because diagnosis may rely on exclusion of other causes of ulcers.…”

Section: Antineutrophilmentioning

confidence: 99%

“…6,10 Ulcerative PG typically occurs on lower extremities, therefore, an unusual location of PG-like ulceration, particularly on the head and neck area or upper extremities, should raise suspicion for alternative diagnosis and prompt ANCA testing. 4 Distinction between PG and PG-like ulcers of AAV should rely on correlation of histopathological features, laboratory testing, and systemic organ involvement as summarized in Table 2. To capture this group of patients it is essential they are seen in a timely fashion by clinicians who are familiar with the clinical findings of PG as well as the characteristic histopathological findings in order to carry out correlation with all findings including laboratory tests.…”

Section: Reportmentioning

confidence: 99%

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Pyoderma gangrenosum‐like skin ulceration in antineutrophil cytoplasmic antibody‐associated vasculitis: a retrospective case series

Shakshouk¹,

Gibson

2022

Clin Experimental Derm

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Antineutrophil cytoplasmic antibody‐associated vasculitis (AAV) can be associated with various cutaneous manifestations. Several case reports have described skin ulceration resembling pyoderma gangrenosum (PG), particularly in granulomatosis with polyangiitis (GPA); however, the true incidence of this PG‐like ulceration in various diseases is unknown. In addition, PG is frequently misdiagnosed, and diagnosis may rely on exclusion of other causes of ulcers. We aimed to describe clinical and histopathological features of PG‐like ulcerations occurring in association with AAV and identify clues to differentiate these ulcers from PG. Retrospective search was conducted to include patients with AAV presenting with PG‐like ulcers treated at our institution. This large case series highlights presentation of PG‐like ulcers occurring in patients with AAV. Care should be taken to avoid delayed or missed diagnosis of AAV. Distinction between AAV and PG is challenging yet mandatory for proper treatment. Diagnosis relies on a constellation of detailed cutaneous clinical examination, systemic symptoms or illness, histopathological features and laboratory tests.

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Section: Reportmentioning

confidence: 99%

Section: Reportmentioning

confidence: 99%

Section: Antineutrophilmentioning

confidence: 99%

Section: Reportmentioning

confidence: 99%

See 2 more Smart Citations

Pyoderma gangrenosum‐like skin ulceration in antineutrophil cytoplasmic antibody‐associated vasculitis: a retrospective case series

Shakshouk¹,

Gibson

2022

Clin Experimental Derm

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“…Notably, other processes have been reported to mimic PG as well including bromoderma, cutaneous diphtheria, cutaneous cryptococcus, granulomatosis with polyangiitis, and metastatic Crohn disease [5][6][7][8][9] . This further highlights the importance for a broad initial differential diagnosis in cases clinically resembling PG.…”

mentioning

confidence: 99%

Heroin-induced Ulcer Mimicking Pyoderma Gangrenosum

et al. 2021

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Subcutaneous injections of illicit substances may be performed by some patients citing several advantages by the user, and can present to clinic with ulcers that clinically mimic pyoderma gangrenosum. However, it is vital to recognize heroin-induced ulcers and treat urgently to preserve function. Treatment requires a multidisciplinary approach with general medicine, dermatology, plastic surgery, wound care, infectious disease and addiction medicine. We present a patient with lower extremity ulceration due to subcutaneous injection of heroin which resembled PG.

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Pyoderma gangrenosum-like ulcerations in granulomatosis with polyangiitis: two cases and literature review

et al. 2018

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Granulomatosis with polyangiitis (GPA) is a systemic necrotizing small vessel vasculitis associated with circulating anti-neutrophil cytoplasmic antibodies (ANCAs). Skin manifestations, mostly represented by palpable purpura, papulonodular lesions and livedo reticularis, are present in up to 50% of the cases. Ulcerations with undermined, raised erythematous-violaceous border resembling pyoderma gangrenosum (PG) have rarely been reported as skin involvement in GPA. The presence of circulating ANCAs with a cytoplasmic labelling pattern, the involvement of internal organs, particularly of the lung, and the absence on histology of a mainly neutrophilic infiltrate in early phases of the cutaneous lesions may be regarded as clues to rule out true PG and confirm the diagnosis of GPA skin ulcerations simulating PG. Herein, we describe two paradigmatic cases of such a unique presentation of GPA and a literature review focusing on clinicopathological features of GPA presenting with PG-like ulcerations in the skin has been provided. Moreover, referring to the scenario observed in these two cases, an easy-to-use working approach for the differential diagnosis between the two conditions has also been proposed.

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Granulomatosis with polyangiitis mimicking classic inflammatory bowel disease-associated pyoderma gangrenosum

Cited by 11 publications

References 20 publications

Pyoderma gangrenosum‐like skin ulceration in antineutrophil cytoplasmic antibody‐associated vasculitis: a retrospective case series

Pyoderma gangrenosum‐like skin ulceration in antineutrophil cytoplasmic antibody‐associated vasculitis: a retrospective case series

Heroin-induced Ulcer Mimicking Pyoderma Gangrenosum

Pyoderma gangrenosum-like ulcerations in granulomatosis with polyangiitis: two cases and literature review

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