Pyoderma gangrenosum coexisting with acute myelogenous leukaemia

The frequency of occurrence of malignant neoplasms in the cases of pyoderma gangrenosum is not exactly determined, but it can be assessed to be at 7%. The aim of the study was to report a 26-year-old male patient with pyoderma gangrenosum coexisting with acute myelogenous leukaemia. The first skin lesions on both tibia occurred in June 2001. Prior to the proper diagnosis of pyoderma gangrenosum, the patient was treated surgically. Because of the dramatic dermatological and general condition in November 2001, the patient was admitted to the Dermatological Department of the Silesian Medical Academy in Katowice where the diagnosis of pyoderma gangrenosum was established. On the clinical and biochemical picture, the diagnosis of pyoderma gangrenosum within acute myelogenous leukaemia was made. Initially, cyclosporin A 200 mg orally per day in the therapy of pyoderma gangrenosum was administered to achieve a slight clinical improvement. Although chemotherapy leukaemia was performed, the patient died after 4 months of the confirmation of the acute myelogenous leukaemia diagnosis.     

Pyoderma gangrenosum associated with biphenotypic acute leukemia

Pyoderma gangrenosum is a neutrophilic dermatosis that may be associated with myeloid malignancies. Less information is available about the association of pyoderma gangrenosum with lymphoid malignancies. We present, to our knowledge, the first case of pyoderma gangrenosum associated with biphenotypic acute leukemia wherein the malignant cells show a phenotype specific for myelogenic and lymphocytic leukemia. Histopathologic examination revealed rather nonspecific features without involvement of leukemic cells in the skin lesions. Treatment with systemic steroids was followed by characteristically rapid healing of the skin lesion.     

Pyoderma gangrenosum in a patient with essential thrombocythemia

BACKGROUND: Pyoderma gangrenosum is an uncommon ulcerative condition associated with inflammatory bowel disease, arthritis, and hematologic disease. We report a patient with essential thrombocythemia and pyoderma gangrenosum. OBJECTIVE: This article is a review of the associations between pyoderma gangrenosum and other diseases. RESULTS: There have been two previous reports of patients with pyoderma gangrenosum and essential thrombocythemia. CONCLUSION: There may be a possible association between pyoderma gangrenosum and essential thrombocythemia. The diagnosis of pyoderma gangrenosum should be considered in patients with essential thrombocythemia and cutaneous ulcers.     

Pyoderma gangrenosum in HIV patient

Pyoderma gangrenosum (PG) has previously been reported in very few patients with HIV infection. We describe here a 30-year-old housewife with HIV infection having multiple ulcerations over lower limbs characteristic of PG.     

Pyoderma gangrenosum as an early revelator of acute leukemia

Bullous pyoderma gangrenosum is an atypical, more superficial variety of the classical pyoderma and is often associated with myeloproliferative disorders. We present the case of a patient who presented initially with subcutaneous nodules and who developed bullous lesions afterwards. Histological evaluation showed the presence of neutrophilic infiltrates in both lesions. A few months after the diagnosis of bullous pyoderma gangrenosum, an underlying leukemia was revealed. Our case illustrates the importance of regular blood and bone marrow examinations in patients with atypical bullous pyoderma gangrenosum, resulting in a rapid diagnosis of the underlying disease.     

Disseminated candidiasis in a patient with acute myelogenous leukemia

Disseminated candidiasis is a frequently fatal condition that is rising steadily in immunocompromised patients. We present the case of a 62-year-old African American woman with acute myelogenous leukemia who developed characteristic cutaneous signs of systemic candidiasis. Early cultures and biopsies resulted in early diagnosis, which prompted proper antifungal therapy and a positive outcome.     

Pyoderma gangrenosum associated with anticardiolipin antibodies in a pregnant patient

A 40-year-old pregnant woman at 17 weeks of gestation presented with a 10-day history of pain and erythema in the right leg. She had experienced a similar episode in the postpartum period (1 week) 14 months earlier, lasting 2 months. This was diagnosed as cellulitis and resolved following antimicrobial therapy. The patient had no fever or chills. Pertinent past medical history involved a possible history of ampicillin allergy. The initial differential diagnosis included cellulitis and thrombophlebitis. Antibiotic therapy with intravenous (IV) cefazolin was started at the same time as anticoagulation with heparin. Over the next few days the ulceration enlarged. No microbial growth was detected on wound cultures and Doppler studies carried out prior to admission revealed normal venous flow. The patient did not respond to therapy. A dermatology consult was requested. When the patient was first examined by us, the ulceration had been progressively increasing in size. There was an oozing ulcerated patch 7 cm in diameter on the right distal medial thigh (Fig. 1). The ulcer contained crater-like holes and fistulous tracts from which pus could be expressed upon application of pressure. The surrounding border was undermined and violaceous. A clinical diagnosis of pyoderma gangrenosum (PG) was made. Antinuclear antibodies and antibodies to Smith antigen were negative; anticardiolipin antibody was positive. A 3-mm punch biopsy showed an intense neutrophilic response with fibrinoid change in some vessels (Fig. 2), which was felt to be consistent with PG with a concomitant small vessel vasculitis. No fibrin thrombi were noted. The heparin was replaced with aspirin and the IV antibiotics were changed to oral cephalexin. Intralesional triamcinolone (40 mg/cc) was started and a 3-day course (80 mg/40 mg/20 mg) of oral prednisone was initiated. Within 2 days of starting steroid therapy, the inflammation and discharge were greatly reduced. Approximately 2 weeks after admission the therapy was noted to halt the progression. The lesion became more well demarcated with healthy granulation tissue and decreased tenderness and warmth. The patient was discharged on Burow's solution, saline soaks, and bacitracin and was seen by us on two occasions after discharge for intralesional steroid administration. One flare-up since discharge was controlled by increasing her prednisone from 10 mg to 20 mg daily. The patient had premature rupture of membranes at 37 weeks, had a spontaneous vaginal delivery, and delivered a healthy baby boy weighing 5 Ib 14 oz. Since then, the ulcer had re-epithelialized with tapering doses of prednisone.     

Pyoderma gangrenosum following cesarean delivery

We describe the case of a 30-year-old woman who, 5 days after giving birth to her first child by cesarean section, presented with dehiscence of one end of the surgical wound and a lesion on her leg that developed into a well-defined ulcer; both lesions were very painful. The patient was initially diagnosed with a skin infection and later with superficial pyoderma gangrenosum. The lesions were treated with topical corticosteroids and a good response was observed. No evidence was found of underlying disease. Isolated cases of pyoderma gangrenosum associated with pregnancy or cesarean delivery have been reported in the literature. The etiology of pyoderma gangrenosum is currently unknown, but some theories suggest an immunologic mechanism. Gestation is known to generate a state of immune tolerance that could play a role in the development of the disease and future studies may help to clarify the significance of this association.     

Pyoderma gangrenosum in a patient with bullous systemic lupus erythematosus

We report a 55-year-old woman with bullous systemic lupus erythematosus, who later developed pyoderma gangrenosum (PG). Dapsone was effective for the eruption of bullous bullous systemic lupus erythematosus but not for pyoderma gangrenosum. Cyclosporine was effective for the skin lesions of pyoderma gangrenosum. This is the first reported case of PG associated with bullous systemic lupus erythematosus.     

Pyoderma gangrenosum with secondary pyarthrosis following propylthiouracil

The association of pyoderma gangrenosum and arthritic symptoms is well documented. We present a rarely reported variant of this in a 44-year-old woman with pyoderma gangrenosum and bilateral large purulent effusions of her knees. She had no evidence of underlying rheumatoid arthritis or a specific seronegative spondyloarthropathy. Of note she had a history of Graves' disease for which she had been treated with propylthiouracil for 3 years and on investigation at this presentation had a markedly elevated perinuclear antineutrophil cytoplasm antibody (P-ANCA) level with specificities for IgM myeloperoxidase, IgG elastase and IgG lactoferrin. We believe this patient had pyoderma gangrenosum with secondary sterile pyarthrosis and a P-ANCA precipitated by propylthiouracil.     

Pyoderma gangrenosum over a saphenectomy scar in a cANCA-positive patient with diverticulitis

Pyoderma gangrenosum is a chronic, painful, ulcerative skin disease of unknown etiology. In 50 % of the cases, it is associated with systemic disease, primarily with inflammatory bowel disease. It can develop over areas of trauma or surgical wounds, possibly because of local immunoreactant deposits. We describe the case of a cANCA-positive patient with colonic diverticulitis who developed pyoderma gangrenosum over a saphenectomy scar.     

Pyoderma gangrenosum in a patient with autoimmune haemolytic anaemia and complement deficiency

About 50% of cases of pyoderma gangrenosum (PG) are associated with a variety of systemic diseases. We describe a patient with severe PG on both legs who suffered from an autoimmune haemolytic anaemia in association with a congenital deficiency of complement factors C2 and C4. To the best of our knowledge, this constellation has not been previously reported.