Skin Ulcers Misdiagnosed as Pyoderma Gangrenosum

Weenig, Roger H.; Davis, Mark D.P.; Dahl, Patrick R.; Su, W.P. Daniel

doi:10.1056/nejmoa013383

Cited by 330 publications

(312 citation statements)

References 46 publications

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Section: Discussionmentioning

confidence: 85%

“…The history of trauma prior to the ulceration, for example, could raise the hypothesis of sporotrichosis and pyoderma gangrenosum [12,13]. However, considering the aspect and the evolution of the ulcerated lesions in the pyoderma gangrenosum, the typical ulcer would be preceded by papules, pustules or vesicles, it would be very painful and rapidly progressive, which differentiates it from the described case [12,13]. With the type and evolution of lesions still in mind, we could consider the hypothesis of cutaneous leishmaniosis, in which the primary lesion is generally singular and painless, with raised and hardened edges and a "bottom" with granulation tissue, prominently localized in uncovered body parts and in endemic areas.…”

Section: Discussionmentioning

confidence: 99%

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Differential Diagnosis of Ulcerative Cutaneous Lesions: the Emergence of Buruli Ulcer in Western European Countries

Marques¹

2016

MOJCR

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The Buruli ulcer (BU), secondary to the infection by Mycobacterium ulcerans, is considered by the World Health Organization (WHO) to be a neglected tropical disease. Despite being the third most common mycobacteriosis, reported in more than 30 countries, it is the one that raises the most epidemiological doubts. Clinically, it manifests itself as a painless and necrotizing lesion of the skin, subcutaneous tissue and bone. Typically, it occurs on lower limbs, having several possible clinical manifestations (nodules, papules, plaques, edema and/ or ulcers). Fibrosis and contractures resulting from the healing process are the factors responsible for stigmatization and morbidity associated to BU. The WHO recommends treatment with double antibiotic therapy for a period of eight weeks, even in the presence of a suspected case without laboratorial confirmation. Despite the vast knowledge about the Buruli ulcer in endemic countries, in Western European countries such as Portugal this diagnosis may be overlooked. We present a clinical case to illustrate the importance of the diagnostic suspicion and timely treatment in the prognosis of BU patients.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Differential Diagnosis of Ulcerative Cutaneous Lesions: the Emergence of Buruli Ulcer in Western European Countries

Marques¹

2016

MOJCR

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“…In doubtful cases the diagnosis is confirmed through a process of elemination of other causes of cutaneous ulcers. 7 Table 1 presents diseases which were excluded in the process of establishing the diagnosis in our patient. Occasionally coexistence of predisposing diseases 8,9 may be a useful hint for the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

A case of atypical pyoderma gangrenosum

Vasili

Shkodrani²,

Labinoti³

et al. 2010

J Dermatol Case Rep

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Background: Pyoderma gangrenosum is a rare inflammatory disease of unknown etiology and unspecific histopathology. There are no clear-cut criteria for the diagnosis of this disease. The diagnosis is usually made based on clinical appereance, course of disease and possible, commonly coexisting disorders. In atypical cases the diagnosis is based on exclusion of other causes of similar appearing cutaneous ulcerations.Main observations: The 67-year-old male patient, presented with a 15-year history of painful ulcers and vegetative lesions covered with sero-hemorrhagic and purulent secretions, localized on the dorsal surface of both hands leading to self-amputation of distal phalanges. We report a step-by-step The patient refers to have these complaints for more than 15 years. An extensive diagnostic procedure led to the diagnosis of pyoderma gangrenosum as a diagnosis of exclusion.Conclusion: This report shows an atypical variant of an ulcerative disease. Pyoderma gangrenosum, a diagnosis of exclusion, was sustained based on an extensive diagnostic procedure. In this article we describe the step-by-step approach which let to this diagnosis.

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“…I think these lesions are compatible with pyoderma gangrenosum (PG)-liked lesions. There are 4 variants of PG including (a) ulcerative lesions: the association includes autoimmune disease, hematologic malignancy, and IBD, (b) vesicobullous lesions: the association includes autoimmune disease, hematologic malignancy, and IBD, (c) pustular lesions: the association includes IBD, and (d) vegetative lesions: the association includes chronic kidney disease [4]. The causes of PG includes vascular occlusive diseases (e.g.…”

Section: Other Processes Including Sarcoidosis Druginduced Midline Dmentioning

confidence: 99%

Chronic progressive sinusitis unresponsive to conservative treatment

et al. 2014

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Skin Ulcers Misdiagnosed as Pyoderma Gangrenosum

Abstract: The misdiagnosis of pyoderma gangrenosum is not uncommon and exposes patients to risks associated with its treatment. A thorough evaluation is required in all patients suspected of having pyoderma gangrenosum in order to rule out alternative diagnoses.

Cited by 330 publications

References 46 publications

Differential Diagnosis of Ulcerative Cutaneous Lesions: the Emergence of Buruli Ulcer in Western European Countries

Differential Diagnosis of Ulcerative Cutaneous Lesions: the Emergence of Buruli Ulcer in Western European Countries

A case of atypical pyoderma gangrenosum

Chronic progressive sinusitis unresponsive to conservative treatment

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