坏疽性脓皮病1例

临床资料 患者，男，63岁，因左下肢溃疡1年，于2003年8月23日来诊。患者1年前发现左下肢小腿胫前黄豆大的丘疹，微痒，自行抓破，结疡，破溃，如此反复，后形成深在性溃疡，长期不愈合，加重时伴有疼痛。溃疡面逐渐扩大，加深，在其下方出现新的结节、溃疡。不伴发热、并节疼痛等全身不适症状。在当地医院按感染，给予多种抗生素治疗，效果不明显，     

坏疽性脓皮病1例

报告1例坏疽性脓皮病。患者男,49岁,全身多发结节、溃疡伴疼痛反复发作2年,加重3月。溃疡可自行愈合,形成菲薄的萎缩性瘢痕。组织病理检查符合坏疽性脓皮病表现。给予糖皮质激素及免疫调节剂获良效。     

坏疽性脓皮病1例

坏疽性脓皮病是一种慢性复发性溃疡性皮肤病，皮损形态和组织病理有一定特征。但病因不明，常合并系统性损害如炎性肠病、关节炎、肿瘤等。现将笔者遇到的1例报告如下。     

坏疽性脓皮病1例

坏疽性脓皮病（pyodemla gangrenosum．PC）是一种以皮肤破坏性溃疡为特征的反应性炎症性皮肤病,临床少见。笔者诊治1例并发茄病镰刀菌感染的坏疽性脓皮病患者,现报告如下．[第一段]     

坏疽性脓皮病1例

1临床资料 患者男,54岁.入院前20余天开始无明显诱因双足皮肤出现多处红肿,伴疼痛,并迅速出现溃烂,在当地医院诊疗(具体不详),无明显效果,溃烂及疼痛加重,遂至本院就诊.患者既往体健,否认有高血压、糖尿病等系统性疾病史,家族史无特殊.体检:T 38.5℃,血压正常,浅表淋巴结无明显肿大,不能正常站立和行走,其它系统检查未见明显异常.     

坏疽性脓皮病1例

患者张××,女,60岁。1989年7月右小腿外伤后胫前起一红色丘疱疹,疼痛,后自行破溃形成溃疡直径约1cm,日益恶化扩大,无发热,局部疼痛明显。在当地静滴及外用抗菌药物治疗,皮损未能控制,迅速发展为大片溃疡,2个月后由外院转我院外科,以下肢感染予以抗菌素肌注,每日清创换药,皮损表面由外向内缩小,但仍呈潜行性发     

坏疽性脓皮病1例

患儿，男，７岁。１９９６年元月初发热、咳嗽，背部相继出现水疱、溃烂、结痂，皮疹向身体各处漫延。当地医院予强的松３０ｍｇ／ｄ治疗，未见好转。于７月３０日入院。皮肤科情况：右上眼睑红肿，右眼内眦、颈、躯干、四肢、外生殖器可见多数指甲盖至银币大小，圆形或椭...     

坏疽性脓皮病1例

患者男,19岁。因双下肢疼痛性溃疡1个月伴发热半个月,于2004年10月14日入院。患者1个月前无明显诱因双小腿出现疼痛性丘疹、脓疱,挤压后破溃,流出少量脓液,逐渐发展成硬币大溃疡,1个月后增至手掌大。在当地医院取分泌物行细菌及真菌培养均为阴性,诊断为“慢性溃疡”。予以静脉滴注硫酸阿米卡星、地塞米松、头孢拉定等治疗,溃疡面仍逐渐增大。入院体格检查：T39.0℃,系统检查未见异常。     

坏疽性脓皮病1例

患者男性，41岁，因全身皮肤反复出现脓疱、脓痴伴疼痛15年人院。于1983年冬，明显无诱因，患者躯干部皮肤出现散在丘疹、脓疤。数日后上述皮损下出现红肿，呈疖肿样损害。继之脓疤破溃，有淡绿色脓液溢出，不治自愈。愈后留有瘢痕。15年来，病情反复数十次，皮损扩展至四肢和头面部。每次发病时，皮损部位有疼痛，严重时有剧痛。无高热、无明显溃疡。脓液由皮损边缘瘘口排除后，皮损中心不断愈合，但同时又逐渐向四周呈远心性扩大。曾在本院应用强的松、氯喹、青霉素治疗，皮损完全消退，一年后复发。自述皮损不治可自愈，最长1年，最短1个…     

Pyoderma gangrenosum complicated by herpes simplex virus infection

High-dose immunosuppression used in the treatment of pyoderma gangrenosum predisposes patients to opportunistic infections. A 66-year-old man presented with recalcitrant pyoderma gangrenosum in which the ulcer itself became infected with herpes simplex virus type 1. This patient was immunosuppressed with multiple agents including topical and oral corticosteroids, cyclosporin, mycophenolate mofetil, intravenous immunoglobulin and infliximab. However, the patient's ulcer continued to extend despite this. It was not until the presence of this virus was detected using polymerase chain reaction on a viral swab of the lesion and oral aciclovir was commenced that the ulcer began to heal. In addition, a fungal granuloma developed on this patient's left forearm as a complication of the potent immunosuppression, which was resolved following treatment with oral voriconazole.     

Pyoderma gangrenosum or leukaemia cutis?

We report a case of atypical bullous pyoderma gangrenosum associated with acute myeloid leukaemia in which we found atypical myeloid cells within the skin lesion. Although there have been many reported cases of leukaemia-associated pyoderma gangrenosum, the finding of myeloblasts in the skin has rarely been described.     

Pyoderma gangrenosum in two siblings: a familial predisposition

We report pyoderma gangrenosum in two siblings with onset during childhood and no associated systemic abnormalities. The patients were born of nonconsanguineous, healthy parents. Treatment with oral corticosteroids produced an excellent clinical response, followed by recurrence after cessation of therapy. Steroids were restarted in combination with dapsone to prevent further recurrence.     

Pyoderma gangrenosum in childhood

We have treated 4 cases of pyoderma gangrenosum in infancy and childhood in past 2 years. The ages at onset were 6 months, 8 months, 6 months and 11.5 years respectively. Initial lesions were papulopustular in 3 and nodular in 1 patients but later on all of them developed ulcerative lesions with erythematous, violaceous, infiltrated or undermined edges. The lesions were numerous in 3 patients but few in 1 patient. The first patient had very high leucocyte count. In the second patient skin lesions of PG followed measles vaccinations. We could not reveal any association in the other two patients. None of the patient responded to antibiotic therapy. Three patients were treated successfully with dapsone and one with a combination of dapsone and prednisolone. We conclude that pyoderma gangrenosum is not so rare in infancy and it is more likely to occur without associated systemic diseases.     

Pyoderma gangrenosum in childhood

A review of our records disclosed eight children with pyoderma gangrenosum. All had associated inflammatory bowel disease, and four had arthritis. In three patients the bowel disease was severe and required resection of portions of the affected bowel. The cutaneous lesions had a chronic course (average duration, 2 1/2 years), and systemic therapy was required in seven cases. Previously reported cases of pyoderma gangrenosum in children are reviewed, and the management of this skin disorder in childhood is discussed.