Pyoderma gangrenosum requiring inpatient management: a report of 26 cases with follow up

We present a case series of inpatients with pyoderma gangrenosum (PG), an ulcerative neutrophilic skin condition of unknown aetiology. Twenty-six patients were admitted with PG, nine men and 17 women. At the time of the chart review, seven patients (26.9%) had died. Patients had a mean of 2.0 active ulcerative lesions and 22 patients' ulcers (84.6%) were on the lower limb. Systemic diseases were coexistent in 15 patients (57.7%), the most common being rheumatoid arthritis (19.2%). Thirty-eight wound cultures were taken and were positive for Staphylococcus aureus in 22 cases (57.8%) and Pseudomonas aeruginosa in 20 (52.6%). After prednisolone, cyclosporin was the next most commonly prescribed systemic therapy (34.6%). Surgical debridement was undertaken in seven cases (26.9%) and two patients had skin grafts. Upon discharge from hospital, 21 patients' ulcers (80.8%) had improved. At 6 months 50% showed complete ulcer healing. Our results highlight the potential severity of PG requiring hospital admission, the need for aggressive therapy and the overall high associated morbidity and mortality.     

Improvement of ulcerative pyoderma gangrenosum with hyperbaric oxygen therapy

Pyoderma gangrenosum (PG) is a rare noninfectious destructive neutrophilic dermatosis of unknown origin affecting the skin and occasionally the subcutaneous fat. In this report, we present the results of intensive hyperbaric oxygen (HBO) therapy in a 62-year-old Greek woman who had been diagnosed with ulcerative PG two years ago, but had been resistant to other therapies.     

Etiology of chronic leg ulcers in 31,619 patients in Germany analyzed by an expert survey

Background: The etiology of chronic leg ulcers is heterogenous and they exhibit quite different healing rates depending on the underlying cause. Although the prevalence and incidence of chronic leg ulcers appear to be increasing, data on these patients in Germany are lacking. Patients and Methods: Altogether 100 German wound care professionals were asked to complete a questionnaire regarding the diagnosis and etiology of their patients with chronic leg ulcers. Results: We received the data on 31,619 patients. In these patients, venous insufficiency was the dominating causative factor in 47.6 % and arterial insufficiency in 14.5 %, 17.6 % of ulcers were due to combined arterial and venous insufficiency. Rarer causes included vasculitis (5.1 %), exogenous factors (3.8 %), pyoderma gangrenosum (3.0 %), infection (1.4 %), neoplasia (1.1 %), calciphylaxis (1.1 %) and drug‐induced (1.1 %). The used diagnostic methods used varied widely between the medical and surgical specialties. Conclusions: Even though the results of our study cannot claim to be a representative overview, they demonstrate clearly that next to known etiologies, e. g. chronic venous insufficiency or peripheral arterial insufficiency, which are relevant in 79.7 % of all patients a multitude of other causes exist, which are responsible in 20.3 % of all patients for the development of chronic leg ulcers.     

Cutaneous Manifestations of Multiple Myeloma

Multiple myeloma (MM) is a proliferative disorder of plasma cells which produce abnormal immunoglobulin proteins. Skin involvement is rarely found in this disorder. They are either specific or nonspecific lesions. We report four such interesting patients who presented to us initially with common dermatoses such as leukocytoclastic vasculitis, pyoderma gangrenosum, and vesiculobullous disorders and were subsequently diagnosed to have MM. There were no skeletal involvements or renal function abnormality at the time of presentation. Unusual presentation, nonresponsiveness to conventional therapy, and abnormal blood parameters prompted us to suspect some underlying systemic conditions which were later confirmed to be MM after serum immunoelectrophoresis for M-band and bone marrow biopsy.     

拔甲后继发感染一例

摘 要:报道1例粪肠球菌引起芽生菌病样脓皮病。61岁男性患者双足拇趾拔甲术后出现不规则形增殖性斑块,伴黄褐色痂皮及较多脓性分泌物。脓液和组织培养显示粪肠球菌。组织病理示角化过度伴角化不全,表皮呈假上皮瘤样增生,表皮内脓肿形成,内含中性粒及嗜酸性粒细胞为主浸润。患者对足量系统抗生素治疗反应好。     

A case of pyoderma gangrenosum responding to high-dose intravenous immunoglobulin therapy

Pyoderma gangrenosum （PG） is a rare ulcerative cutaneous condition with distinctivecharacteristics, and the aetiology is not clear yet. PG is commonly associated with inflammatory bowel disease including ulcerative colitis and Crohn＇s disease. This condition is within the spectrum of the neutrophilic dermatoses. The features of PG are not specific histopathologically. Commonly, it is characterized by the presence of marked neutrophilic infiltrates in the dermis. The treatment of PG usually requires systemic corticosteroids or other immunospressive medications, and its course is chronic and relapsing. Some cases are resistant to these treatments. On the other hand, long-term usage of those medications naturally causes serious side effects, and an alternative effective and safe therapy is required to avoid the clinical problems associated with the drugs.     

Pyoderma gangrenosum associated with severe oropharyngeal involvement and IgA paraproteinaemia

We report a patient with combined cutaneous and oropharyngeal pyoderma gangrenosum in association with an IgA lambda paraproteinaemia. The differential diagnosis of oral pyoderma gangrenosum is discussed.     

Inflammatory bowel disease at the korle bu teaching hospital, accra

SummaryCase files of patients with Inflammatory Bowel Disease (IBD) managed by the author in the Medical Department over the period 1997 - 2004 have been reviewed to identify some features of the disease that may aid improved diagnosis and management. The findings indicate that IBD may not be rare in the country and that there is usually a long delay in establishing the diagnosis. It appears that, in Ghana, more males than females are affected and that most are fifty years of age or below. Malignant colonic change is uncommon but there is a high default rate among the patients. Five patients (29%) died. Cases managed in an Arab country, between 1987 and 1996, have been compared. In that group more female than male patients were affected but the commonest age group affected was similar. The diagnosis was similarly delayed but no deaths were recorded as opposed to the Ghana patients. Since Inflammatory Bowel Disease (IBD) is a potentially treatable condition medical practitioners need increased awareness to avoid undue delay in diagnosis.     

Pyoderma gangrenosum associated with Takayasu's arteritis responding to cyclosporin

A 33-year-old caucasian woman with pyoderma gangrenosum associated with Takayasu's arteritis responded to treatment with cyclosporin. This patient is unusual in that both ulcerative and vesiculopustular forms of pyoderma gangrenosum were present. This has not previously been reported with Takayasu's arteritis.