Pyoderma Vegetans Associated with Ulcerative Colitis: A Case with Good Response to Steroids

Abstract

Pyoderma vegetans (PV) is a very rare disorder characterized by erythematous, vesiculopustular, exudative, vegetating plaques usually localized in the inguinal and axillary folds. The etiology of PV is not known, but it is often associated with bacterial infections in immunocompromised patients. Major histopathological features in PV are pseudoepitheliomatous hyperplasia and intraepidermal and subepidermal neutrophilic or eosinophilic microabscesses. It is well known that these lesions are frequently associated with inflammatory bowel diseases, such as ulcerative colitis (UC) and Crohn’s disease. No standardized treatment plan is available for PV, although antibiotic treatment has often been used, with variable results. The standard first-line therapy is still systemic steroids. Herein, we report a case of PV associated with UC with unusual localization that showed a good response to systemic corticosteroid, antibiotic and sulfasalazine therapy.

Vulvar pseudoepitheliomatous hyperplasia associated with herpes simplex virus type II mimicking cancer in an immunocompromised patient

“…Some even discourage its use . However, successful corticosteroid treatment for similar pathological conditions, for example, pyoderma vegetans associated with bacterial infection, has been reported . Excellent response was demonstrated in our patient when systemic steroid was added to the oral acyclovir and imiquimod.…”

Pyoderma Vegetans – a Case Report

“…This dose should be continued until the lesions show evidence of healing and then, gradually decreased. A steroid-sparing agent, such as minocycline, dapsone, rifampicin, vancomycin or clofazimine may be added (6,7). However, these treatment modalities were found to be completely ineffective in our patient.…”

“…Other diseases that might be associated with this condition include inflammatory bowel disease, cutaneous T-cell lymphoma, primary immunodeficiency, chronic myeloid leukemia, alcoholism, HIV infection and nutritional deficit. However, it has also been reported in healthy persons (4,6). Major histopathological features of PV are pseudoepitheliomatous hyperplasia and intraepidermal and subepidermal neutrophilic or eosinophilic micro-abscesses (1).…”

Pyodermatitis vegetans after total colectomy

“…[ 5 ] Although intertriginous surfaces are most commonly affected regions, extraordinary localizations have been reported in the literature. [ 6 ] Canpolat et al . reported a patient with pyoderma vegetans on the fingers of the left hand and the foot.…”

“…[ 5 ] Systemic dapsone, azathioprine, cyclosporine, isotretinoin, infliximab, etanercept, methotrexate, and subtotal/total colectomy are other treatment options. [ 1 2 3 4 5 6 ]…”