1.The great mimicker: A case report of an extensive pyoderma gangrenosum in a 39-year-old Filipino female treated with systemic corticosteroids and antibiotics
Camille Joyce J. Crisostomo, MD, DPDS ; Niñ ; a A. Gabaton, MD, FPDS
Journal of the Philippine Dermatological Society 2023;32(1):53-56
Introduction:
Pyoderma gangrenosum (PG) is a rare inflammatory disease with unknown etiology. Ulcerative PG presents with a rapidly
enlarging painful ulcer with erythematous and undermined border often misdiagnosed as infection, vascular disorder, malignancy, and
other inflammatory disease. Hence, this poses a diagnostic challenge for clinicians leading to a delay in the management and significant
morbidity. The treatment of PG is equally challenging due to the rarity of the disease and the scarcity of clinical trials. Currently, there are
no clinical practice guidelines for the management of PG.
Case Report:
Our patient presented with multiple large ulcers with erythematous and undermined borders over the chest, abdomen, and
the lower back. Cribriform scars and contractures were noted as well. She underwent several sessions of surgical debridement and was
given different broad-spectrum antibiotics with noted worsening of the lesions. Due to extensive involvement of the disease, her quality of
life has been significantly affected. A diagnosis of PG was made after the biopsy showed predominantly neutrophilic infiltrate. Prednisone
1mg/kg/day and clobetasol propionate ointment were initiated with significant decrease in pain and size of the ulcers after one month of
therapy. Doxycycline was used as an adjunct therapy with excellent response.
Conclusion
Pyoderma gangrenosum is a rare, debilitating disease that remains a diagnostic dilemma. The worsening of ulcers despite
surgical debridement and antibiotics is a clue that should prompt clinicians to consider PG. This case highlights the important role of dermatology in individuals who present with non-healing chronic ulcers because as seen in this case, not all ulcers are just ulcers.
pyoderma gangrenosum
;
neutrophilic dermatosis
;
ulcers