Pyoderma gangrenosum: clinicopathologic correlation and proposed diagnostic criteria

Su, W.P. Daniel; Davis, Mark D.P.; Weenig, Roger H.; Powell, Frank C.; Perry, Harold O.

doi:10.1111/j.1365-4632.2004.02128.x

Cited by 510 publications

(564 citation statements)

References 137 publications

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“…Diagnosis of PG is a process of exclusion with laboratory tests and histopathology serving only to exclude infection, ischemia, vasculitis and malignancy (1). Nevertheless, certain clinical features can raise suspicion of PG (1).…”

Section: Discussionmentioning

confidence: 99%

“…Although the aetiology is unclear, PG may involve dysfunctional innate immune responses (3): 70% are associated with underlying inflammatory bowel disease and inflammatory arthritides (4,5). It can occur spontaneously but is commonly precipitated by dermal injury in a process termed 'pathergy' (1,6).…”

Section: Introductionmentioning

confidence: 99%

“…Biopsy histopathology tends to show nonspecific neutrophilic inflammation indistinguishable from other ulcerative processes (1). A diagnosis of PG relies on recognition of subtle clinical features (1), some specific to PG after breast surgery (7).…”

Section: Introductionmentioning

confidence: 99%

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Pyoderma gangrenosum following autologous breast reconstruction

et al. 2017

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Pyoderma gangrenosum (PG) is an uncommon disorder characterized by the development of painful cutaneous ulceration, commonly precipitated by dermal injury at surgical sites. It is a diagnostic challenge as it manifests as necrotizing wounds which are commonly misdiagnosed as postoperative wound infection or ischemia. We discuss the clinical features and histopathological findings that allow for rapid identification of PG following autologous breast reconstruction and suggest an algorithm to aid diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pyoderma gangrenosum following autologous breast reconstruction

et al. 2017

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“…Non-dermatologic manifestations have been described, including ocular, pulmonary, splenic, cardiac, and joint involvement [1]. Pathergy, or exacerbation of a wound following trauma, is a key feature in PG, and is familiar to some clinicians more for its association with Behçet's disease [2][3][4].…”

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confidence: 99%

Pyoderma gangrenosum near a cystostomy catheter

2017

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A 78-year-old man with chronic lymphocytic leukemia and neurogenic bladder with an indwelling suprapubic cystostomy presented with a small, painful lump surrounding his catheter site. The throbbing, lancinating pain started after a routine outpatient catheter exchange at his urologist's office. He reported that the pustule spread in a centrifugal fashion, and degenerated into an ulcer. He was prescribed cephalexin for presumed cellulitis by his primary care doctor.In the ensuing 72 h, the lesion continued to expand and was accompanied with increased pain despite taking antibiotics. He reported subjective fevers and night sweats, and subsequently presented to an outside hospital, where he was hospitalized for 5 days to receive intravenous antibiotics for presumed failure of oral therapy. He received vancomycin and piperacillin-tazobactam empirically. His blood cultures were negative for bacteria and fungi, and because of a mild improvement in symptoms, he was discharged home with amoxicillin-clavulanic acid to complete a 10-day course. His wound did not improve. He re-presented 5 days after discharge with worsening, uncontrolled pain and a continuously sprawling ulcer.Vital signs upon presentation showed a temperature of 38.4°C, heart rate of 121 beats/min, blood pressure of 144/81 mmHg, and respiration rate of 18 breaths/min. Abdominal examination revealed normal bowel sounds throughout, no tenderness to palpation away from the ulcer site, non-tender splenomegaly, and no rebound tenderness or guarding. Skin examination on the lower abdomen demonstrated a 30 9 10 cm ulcer with gunmetal gray, undermined borders (Fig. 1). He had exquisite tenderness to light touch over the ulcer. Laboratory studies showed a complete blood count consistent with a known pancytopenia from chemotherapy received 4 months previously, noting that his white blood cell count of 3270/lL (ANC 2808/lL), hemoglobin 8.8 g/dL, and platelet count of 100,000/lL were relatively unchanged. A peripheral blood smear was consistent with chemotherapy-induced pancytopenia. Urinalysis, liver function, and coagulation studies were within normal range. Urine and serum antigen studies for Histoplasma capsulatum and Blastomyces dermatitidis were negative. Repeat blood cultures were negative for fungal elements and bacteria. Abdominal computed tomography scan showed superficial abdominal wall stranding, but no signs of abscess. A biopsy of the ulcer edge showed a diffuse dermal infiltrate composed of mature neutrophils. Gram stains and special stains for microorganisms (Periodic Acid Schiff, Gomori Methenamine Silver, and Acid-Fast Bacilli) were negative for any bacteria and subsequent tissue culture yielded no growth. The biopsy site also was exquisitely painful and started to spread. His painful lesion progressed despite treatment with vancomycin and meropenem for 5 days and his pain was inadequately controlled despite multiple analgesics.Given his failure to improve with broad spectrum antibiotics, the onset of his illness was revisited. He stressed that the...

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“…The aggressive form may cause painful ulcerative lesions, with necrotic and hemorrhagic base 5 . It is associated with systemic disease in about 50% of the cases, such as rheumatoid arthritis, inflammatory bowel disease, paraproteinemia and myeloproliferative disease 6,7 . It is described as one of the extraintestinal manifestations for the patients who have inflammatory bowel disease (IBD), especially the severe forms of unspecified ulcerative proctocolitis (UUP) 8,9 .…”

Section: Introductionmentioning

confidence: 99%

Pyoderma gangrenosum as a initial manifestation of ulcerative proctocolitis

Fonseca¹,

Motta²,

Rampazzo³

et al. 2011

J. Coloproctol. (Rio J.)

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301FONSECA CB, MOTTA GL, RAMPAZZO A, JUNIOR JCC, FAGUNDES RB. Pyoderma gangrenosum as a initial manifestation of ulcerative proctocolitis. Rev bras Coloproct, 2011;31(3): 301-305.AbstRACt: pyoderma gangrenosum is a rare inflammatory skin condition characterized by progressive and recurrent skin ulceration of destructive course. It is usually associated with rheumatoid arthritis, paraproteinemia, myeloproliferative diseases and inflammatory bowel diseases, especially non-specific ulcerative proctocolitis. In these situations, skin lesions are described as concurrent with the intestinal condition. However, reports on pyoderma gangrenosum preceding intestinal findings are less frequent. The authors describe a case of a woman with febrile condition associated with skin lesions diagnosed by biopsy as pyoderma gangrenosum. Two weeks later, she developed diarrhea, arthralgia and sepsis, being diagnosed as ulcerative proctocolitis. After the administration of the treatment for ulcerative proctocolitis, she showed improvements in sepsis care, remission of diarrhea and regression of skin lesions. This case highlights the importance of considering pyoderma gangrenosum as a manifestation associated with inflammatory bowel disease, regardless of its timing in relation to intestinal symptoms.

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Pyoderma gangrenosum: clinicopathologic correlation and proposed diagnostic criteria

Abstract: Pyoderma gangrenosum is a rare but significant cause of ulcerations. It is a diagnosis of exclusion. Herein, we suggest diagnostic criteria and some historical perspectives on the diagnosis of pyoderma gangrenosum.

Cited by 510 publications

References 137 publications

Pyoderma gangrenosum following autologous breast reconstruction

Pyoderma gangrenosum following autologous breast reconstruction

Pyoderma gangrenosum near a cystostomy catheter

Pyoderma gangrenosum as a initial manifestation of ulcerative proctocolitis

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