Progressive and extensive ulcerations in a girl since 4 months of age: The difficulty in diagnosis of pyoderma gangrenosum

Abstract

A female child developed multiple, progressive, therapy-resistant, painful large ulcers, vesicles, and pustules since her 4 months of age. The ulcers were large, some even measured more than 8 cm; most had violaceous undermined margin with surrounding erythematous halo, raw and crusted surface and were distributed extensively over scalp, face, ear, trunk, buttocks, thigh, legs, dorsum of hands, and feet without any mucosal involvement. After detail clinical examination and investigation, it was diagnosed as a case of pyoderma gangrenosum. Extensive search did not reveal any systemic abnormality or detect any infective etiology. The case highlights the problems of diagnosis of multiple ulcers at very early age.

Refractory Pyoderma Gangrenosum in an Infant

“…Our patient has suffered a more persistent course and required more extensive therapy than in the other seven cases of idiopathic infantile PG described in the literature. Five of the seven infants responded satisfactorily to steroids and wound care alone, whereas the other two required further treatment, one with topical tacrolimus and one with cyclosporine (Table ) . Although our infant partially responded to anakinra, she continued to develop new lesions, and her treatment ultimately included infliximab, cyclosporine, and prednisone.…”

“…Pyoderma gangrenosum (PG) affects about 4% of children . In the past 29 years, 16 documented cases have occurred in infants younger than 1 year of age, 9 of whom had an associated disease (Table ) . There is a dearth of controlled trials, so treatment has been based on case reports.…”

Pulmonary nodules and nodular scleritis in a teenager with superficial granulomatous pyoderma gangrenosum

“…Only six previous cases of pediatric SGPG have been reported. Clinical features, histologic findings, and response to treatment are shown in Table …”

“…Clinical features, histologic findings, and response to treatment are shown in Table 1. 2,3,[5][6][7] Classic PG mainly affects the skin, although extracutaneous involvement has been reported to occur in the lungs, liver, spleen, bones, heart, eye, and meninges. 8 Pulmonary involvement is rare in children with classic PG (seven cases reported) 9 and has not been reported in children with SGPG.…”

Pyoderma gangrenosum in an infant: A case report and review of the literature

“…It is often associated with a concomitant disease, although up to half of cases are considered idiopathic . Infantile PG is even less common, with only 20 cases reported, 11 of which are described as idiopathic, whereas the others are associated with a spectrum of inflammatory, hematologic, and infectious disorders (Table ) . With this report, we add another patient with infantile PG and review the literature for potential treatments.…”