Sporotrichosis Masquerading as Pyoderma Gangrenosum

Spiers, Elizabeth M.; Hendrick, Sophia J.; Jorizzo, Joseph L.; Solomon, Alvin R.

doi:10.1001/archderm.1986.01660180097024

Cited by 23 publications

(8 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Entities that may present similarly include, but are not limited to, necrotizing soft-tissue infections, brown recluse spider bites (necrotizing arachnidism), deep mycoses (eg, blastomycosis and sporotrichosis), vasculopathy, medium-vessel vasculitis, krokodil-induced skin necrosis, and warfarin-induced skin necrosis. 13 14 15 16 …”

Section: Discussionmentioning

confidence: 99%

Fulminant Pyoderma Gangrenosum After Outpatient Knee Arthroscopy

Bates

Sheean²,

Kao³

et al. 2021

JAAOS Glob Res Rev

View full text Add to dashboard Cite

Pyoderma gangrenosum is an immunologic, ulcerative cutaneous condition often associated with systemic disease and frequently precipitated by trauma. It is noninfectious, but the inflammatory assault can resemble a malignant infection such as necrotizing fasciitis. Despite its clinical resemblance to infection, surgical de ´bridement worsens the condition and may remove morphologic clues to the true disease, thus creating a vicious cycle of surgical de ´bridements and disease progression. Furthermore, diagnostic histopathologic and laboratory features are nonspecific, requiring exclusion of other processes. Therefore, appropriate nonsurgical treatment and immunosuppression are commonly delayed, often at a significant cost to the patient. We present a case of pyoderma gangrenosum occurring after outpatient knee arthroscopy that masqueraded as a postsurgical infection. We discuss the diagnostic approach and how a complex reconstruction involving cartilage restoration and soft-tissue coverage was achieved. P yoderma gangrenosum (PG) is an immunologic ulcerative cutaneous condition of an undetermined cause that is often precipitated by trauma. The incidence varies between studies with estimates typically ranging from 3 to 10 per million per year. [1][2][3][4] The disease typically presents in the fourth through sixth decade of life and has a female predominance. 1,[5][6][7] It can be easily mistaken for an infectious process such as necrotizing fasciitis (NF) due to the rapidly progressing wound deterioration in the presence of elevated inflammatory markers and leukocytosis. In contrast to infectious processes, such as NF, surgical débridement promotes the malignant immunologic response, leading to further skin breakdown.A high index of suspicion and the use of a multidisciplinary approach can help differentiate PG from other etiologies, such as a surgical site infection (SSI). Timely workup is paramount because a failure to differentiate the two processes-immunologic and infectious-will lead to misdiagnosis and detrimental interventions. Therefore, early involvement of infectious disease specialists and dermatologists when the diagnosis is in question can help determine whether serial débridements should be initiated or continued.

show abstract

Section: Discussionmentioning

confidence: 99%

Fulminant Pyoderma Gangrenosum After Outpatient Knee Arthroscopy

Bates

Sheean²,

Kao³

et al. 2021

JAAOS Glob Res Rev

View full text Add to dashboard Cite

show abstract

“…[17][18][19] Sporotrichosis is often mistaken for pyoderma gangrenosum when skin nodules are present without involvement of the lymphatic system. Without lymphatic involvement and the classic history of gardening, cutaneous sporotrichosis can easily be mistaken for one of these other disease processes.…”

Section: Discussionmentioning

confidence: 99%

“…The literature contains several reports of sporotrichosis mimicking pyoderma gangrenosum. [17][18][19] Sporotrichosis is often mistaken for pyoderma gangrenosum when skin nodules are present without involvement of the lymphatic system. In our case, pyoderma gangrenosum was considered to be a possible diagnosis until fungal stains demonstrated S. schenckii.…”

Section: Discussionmentioning

confidence: 99%

Disseminated sporotrichosis mimicking sarcoidosis

et al. 2006

View full text Add to dashboard Cite

A 40-year-old Caucasian man presented to the dermatology clinic at Baylor College of Medicine, Houston, Texas, in February 2003, for the evaluation of three nonhealing ulcers. The patient's past medical history was significant for hypothyroidism and pulmonary sarcoidosis, the diagnosis of which was made in June 2000. In March 2000, the patient had complained of cough and shortness of breath. A purified protein derivative (PPD) (Mantoux text) was negative. Computed tomography (CT) scans of the chest revealed diffuse hilar and mediastinal adenopathy and bilateral interstitial and alveolar infiltrates. Although consistent with sarcoidosis, these findings were insufficient to exclude other etiologies, including disseminated fungal infection. Cultures and stains of subsequent bronchoscopy specimens failed to reveal any organisms, and histopathologic evaluation of the specimens was nondiagnostic. Based on the imaging studies and the negative cultures, a diagnosis of sarcoidosis was made, and the patient was started on therapy with prednisone. Before coming to our clinic, the patient had been on several courses of prednisone. In May 2002, the patient had presented to a private dermatologist with a 1-year history of a nonhealing 2.4 cm x 2.0 cm ulcer on the left medial forearm. Two biopsies were reported as nondiagnostic. The patient's presentation was interpreted as most consistent with Mycobacterium marinum infection, and so he was empirically treated with minocycline. This treatment was continued for almost 3 months without improvement in the ulcer. A few months after the minocycline had been discontinued, the patient was treated empirically for 2 months with ciprofloxacin. This treatment was also unsuccessful in ameliorating the ulcer. In between the two courses of antibiotics, specimens from the lesion were sent for bacterial and fungal cultures, which revealed normal skin flora. In January 2003, the patient returned to his private dermatologist with three ulcerations. In addition to the nonhealing ulcer on his left forearm, which he had acquired several months earlier, he had also developed a 3.0 cm ulcer on his right arm and a 3.0 cm ulcer on his central back. The patient refused biopsies at this visit. Given the patient's previous diagnosis of pulmonary sarcoidosis, it was thought that the skin lesions might represent ulcerative cutaneous sarcoidosis. Pyoderma gangrenosum was also considered to be a likely diagnosis. Therefore, the patient was started on a course of oral prednisone, an effective therapy for both sarcoidosis and pyoderma gangrenosum. Despite 1 month of treatment with 60 mg/day of prednisone, the ulcers increased, and the patient was subsequently referred to our clinic. Physical examination at the time of presentation revealed steroid acne on the trunk and upper extremities and three non-tender ulcers with erythematous, undermined borders (Figs 1-3). On the left arm, there was an adjacent nodule which the patient attributed to a scar from a previously healed ulcer. Histologic examination of biopsy ...

show abstract

“…Routine and special histologic stains of skin biopsies, and tissue cultures of bacteria, viral, atypical mycobacteria and deep fungal infections, are required because many of these infectious processes may mimic PG. 18,19 After establishing the diagnosis of pyoderma gangrenosum, patients should undergo evaluation for associated diseases by their primary physicians, because up to 50% of patients with pyoderma gangrenosum have an associated systemic disease. Pustular PG is most commonly encountered in patients with active inflammatory bowel disease, 9 bullous PG is associated with a high frequency of myelodysplastic disease, 11 and vegetative PG is usually not associated with any systemic disease.…”

Section: Goldfrank Et Al • Ed Categorization Standardsmentioning

confidence: 99%

Clinical Pearls: Ulcers on the Fingers

Manthey

Schissel

1999

Academic Emergency Medicine

View full text Add to dashboard Cite

Chief Complaint. Ulcers on the thumb and index finger. History of Present Illness.A 68-year-old woman presents to the ED for evaluation of ulcers on her left thumb and right index finger that appeared after minor trauma. The lesions began as tender erythematous nodules, which progressed and coalesced to pustules. The pustules gradually became more erythematous and began to ulcerate. A dusky hue developed around the margins of the ulcers. This process occurred over a ten-day period.The patient states she had a similar ulcerative process on the buttock and upper thigh region. Treatment at that time included surgical resection of the lesions, which resulted in spreading of the lesions. Subsequently, she was evaluated by a dermatologist and started on oral corticosteroids. The ulcerations slowly resolved, leaving her with large hypertrophic reticulated scars.She denies chemical exposure or arthropod envenomation. She denies diarrhea, bloody stool, fevers, headaches, and joint pain.Physical Examination. The patient's physical examination is normal except for the hands, which reveal 2.7-cm ulcerated lesions on the left thumb ( Fig. 1) and a 1.7-cm lesion on the distal aspect of the right index finger (Fig. 2) Laboratory Studies. The patient has a normal white blood cell count and a normal erythrocyte sedimentation rate.(The diagnosis and discussion appear on page 655.)

show abstract

Sporotrichosis Masquerading as Pyoderma Gangrenosum

Cited by 23 publications

References 8 publications

Fulminant Pyoderma Gangrenosum After Outpatient Knee Arthroscopy

Fulminant Pyoderma Gangrenosum After Outpatient Knee Arthroscopy

Disseminated sporotrichosis mimicking sarcoidosis

Clinical Pearls: Ulcers on the Fingers

Contact Info

Product

Resources

About