Pyoderma gangrenosum associated with ulcerative colitis. Case report and literature review

Abstract

Pyoderma gangrenosum (PG) is currently considered as a reactive inflammatory dermatosis and part of the spectrum of neutrophilic dermatosis.The etiology of PG is still unknown, and its pathophysiology is far from fully understood. Inflammatory bowel disease (IBD), PAPA (pyogenic arthritis, PG and acne) and PAPA-related syndromes often develop with PG. Diagnosis largely depends on careful observation of clinical features and disease progression. We present a case of a 30-year-old patient with an ulcer on the right lower leg who does not respond to standard therapy. The patient has no other accompanying symptoms. After a complete examination, the diagnosis of ulcerative colitis is made, as a very common pyoderma gangrenosum associate disease. A complete examination of cases of ulcers that not respond to the classic therapy is required. PG treatment and diagnosis is a real challenge and requires a wide range of tests.

Multiple vegetative lesions revealing superficial granulomatous pyoderma

“…First described by Wilson-Jones and Winkelmann in 1988 [1], superficial granulomatous pyoderma (SGP) is a rare disease that is considered a variant of pyoderma gangrenosum. SGP differs from the classic form by its indolent clinical course, a lack of an associated and underlying disease, the presence of a granulomatous infiltrate on histology, and a better prognosis with less aggressive therapies [2].…”

“…SGP appears as a superficial ulceration with a clean base and vegetative edges, most often single, painless, and localized at the level of the trunk or the limbs. Histology reveals a granuloma with three zones: an innermost zone of necrotic debris and neutrophils, surrounded by histiocytes and giant cells, and, lastly, encircled by plasma cells and eosinophils [2]. Other histological features include pseudo-carcinomatous hyperplasia, focal hemorrhages, vasculitic lesions, and a neutrophil infiltrate [4].…”