Treatment of pyoderma gangrenosum with oral Tripterygium wilfordii multiglycoside

Two patients with refractory pyoderma gangrenosum (PG) were treated with oral Tripterygium wilfordii multiglycoside (TWG). TWG is a Chinese medicine extracted from a medicinal herb, Tripterygium wilfordii Hook F, and has potent anti-inflammatory and immunosuppressive effects. The effect of TWG on PG was demonstrated by clinical findings. Improvement of the lesions occurred within two weeks, and the ulcers healed about a month. Mild side effects such as gastrointestinal disturbances were observed in both patients. These side effects were patient-acceptable, and there was no need to stop the treatment. Transient elevation of serum ALT was observed in one patient; the serum ALT returned completely to normal after the discontinuation of TWG. These results suggest that TWG may be an effective alternative for refractory PG and that careful monitoring of liver function during TWG treatment is necessary.     

Scabies and pyodermas – diagnosis and treatment

Scabies and pyodermas are two of the commonest skin infections in tropical settings. They affect large numbers of people, particularly children, and account for a large burden of disease for peripheral health care teams. Despite this there have been significant advances in our knowledge of these diseases, their impact and their management. However there is a need to evaluate these developments in this specific setting, tropical health and in the context of communities with limited resources. This section will describe these advances and the challenges that remain.     

Histopathologic features of superficial granulomatous pyoderma

Study of the histopathologic pattern of 28 cases of superficial granulomatous pyoderma demonstrated an ulcerative, verrucous pyoderma of the superficial dermis. Focal abscesses in the subepidermis or dermis were juxtaposed with granuloma formation and plasma cell inflammation. Hemorrhage and granulation tissue were present. The clinical lesions are indolent, and this feature is confirmed by chronic inflammatory elements, including sinus tract formation and focal fibrosis. Superficial granulomatous pyoderma must be added to the histologic differential diagnosis of the vegetative and ulcerative granulomas: blastomycosis, tuberculosis verrucosa cutis, and bromoderma.     

INFANTILE PYODERMA GANGRENOSUM

A six month old female infant with pyoderma gangrenosum is reported. Pyoderma gangrenosum in an infant is rare. The child responded to pulse therapy with intravenous dexamethasone and intralesional triamcinolone acetonide.     

Protracted superficial Wegener's granulomatosis

A 27-year-old woman presented with a right infra-auricular noduloulcerative lesion progressing to a peri-auricular pyoderma gangrenosum-like ulcer with destruction of her right earlobe over an 8-month period. Similar nodules appeared on the right malar and left infra-auricular regions. The cutaneous manifestations were associated with nasal congestion, rhinorrhoea and serosanguineous nasal crusting. Skin biopsy demonstrated suppurative granulomatous inflammation. Investigation of both renal and pulmonary function showed no abnormality. Serological testing revealed a positive cytoplasmic pattern antineutrophil cytoplasmic antibody with high proteinase-3 specificity, which in conjunction with the clinical findings is consistent with a diagnosis of protracted superficial Wegener's granulomatosis. Initial treatment with prednisone 1 mg/kg/day and azathioprine 100 mg/day resulted in complete resolution of her lesions. Reduction of the corticosteroid dose below 0.3 mg/kg/day led to recrudescence of cutaneous and upper respiratory tract symptoms, at which stage methotrexate was substituted for azathioprine with rapid induction of remission and further prednisone withdrawal. Thirty-two months after the initial diagnosis the patient remains well with no other organ involvement.     

Retinal Vasoproliferative Granulomatous Lesion Associated with Hand Pyoderma Caused by Streptococcus pyogenes

Purpose: To report a retinal vasoproliferative granulomatous lesion in association with pyoderma.

Design: Single case report.

Methods: A 32-year-old woman had blurred central vision in the right eye, concurrent with pyoderma of the fingers of both hands, 2 days later followed by fever.

Results: The patient had a granulomatous lesion in the upper retina, which caused leakage, leading to subretinal and intraretinal accumulation of hard exudates in the posterior pole, together with periphlebitis extending over the wider area of the retina. The culture of the pyodermic lesion detected Streptococcus pyogenes. With the 2-month course of amoxicillin–clavulanate, combined with prednisolone tapered from 30?mg daily, the visual acuity (decimal fraction) in the right eye returned from 0.01 (logMAR?=?2) to 0.9 (logMAR?=?0.1). However, after the discontinuation of the antibiotics and prednisolone, the retinal lesion became more vasoproliferative and caused leakage to reduce the vision again. The leakage was remedied by laser photocoagulation to the retinal lesion.

Conclusions: The retinal granulomatous lesion was caused by streptococcal infection in pyoderma and later became more vasoproliferative with macroaneurysms and microaneurysms even after the initial subsidence of the lesion with antibiotics treatment.     

Mycosis fungoides presenting with extensive pyoderma gangrenosum-like ulcers

Mycosis fungoides (MF) may present with atypical clinical manifestations. Usually it mimics various chronic dermatoses, with the appearance of ulcers during the tumour stage. Infrequently, cutaneous ulcers are the main or initial sign of lymphoma. We report the case of a man who presented multiple skin lesions that clinically appeared to be pyoderma gangrenosum (PG). However, histological and immunohistochemical examination revealed MF. This case illustrates that PG-like ulcers maybe atypical cutaneous manifestations of MF and exceptionally the presenting sign of this disease.     

Epidemiology of Streptococcus dysgalactiae subsp. equisimilis in tropical communities, Northern Australia

Streptococcus dysgalactiae subsp. equisimilis (groups C and G streptococci [GCS/GGS]) is an increasingly recognized human pathogen, although it may follow indirect pathways. Prospective surveillance of selected households in 3 remote Aboriginal communities in Australia provided 337 GCS/GGS isolates that were emm sequence-typed. Lancefield group C isolates (GCS) were localized to specific households and group G isolates (GGS) were more evenly distributed. GCS/GGS was more frequently recovered from the throat than group A streptococci (GAS [S. pyogenes]) but rarely recovered from skin sores, and then only with Staphylococcus aureus or GAS. Symptomatic GGS/GGC pharyngitis was also rare. Specific emm sequence types of GCS/GGS did not appear to cycle through the communities (sequential strain replacement) in a manner suggesting acquisition of type-specific immunity. These communities already have high levels of streptococcal and poststreptococcal disease. GCS/GGS may increase in importance as it acquires key virulence factors from GAS by lateral gene transfer.     

Pyoderma gangraenosum-like fungal disease caused by Fusarium solani

Fusariumsolani,widelydistributingovertheenvironment,isarareopportUnishcPathogentohumans.RecentlytheauthorSidentifiedacaseofPyodermaganglae.nostunassociatedwithFusariumsolanihistopathologicallyandmycologically,andtoourknowledge,thisisthefirstcaseeverdescribed.caseA58-year-oldmalewolderpatientsufferingfrom.g~rungandfesteringonhislefteyelids,faceandtempuswithseverepainforoneweekwasabbottedtoourdepal'tlnentonJanuary14,1992.Seventeendaysbeforead..nnssion,hisleftuppereyelidwasinjuredbyasmallsplash…     

Postoperative wound breakdown caused by pyoderma gangrenosum after bilateral simultaneous total knee arthroplasty

Pyoderma gangrenosum is a noninfective necrosis of dermal tissues. Rarely, it occurs after surgery or trauma. However, lack of awareness and its striking similarity to a clinical picture of sepsis usually delay diagnosis and initiation of the correct management. We describe a unique case of its occurrence in both surgical wounds after bilateral total knee arthroplasty and discuss the differential diagnoses and management.