Blastomycosis-like pyoderma: a diagnostic as well as therapeutic challenge.

Abstract

Blastomycosis-like pyoderma is a very rare, chronic inflammatory disorder, which is also known as pyoderma vegetans (PV). It is commonly seen in middle aged males. It is found to be associated with reduced immunity like primary immunodeficiency syndromes, nutritional deficiencies, HIV infection, diabetes mellitus, chronic myeloid leukemia and alcoholism. It tends to have a link with inflammatory bowel diseases. We report a 41-year-old male who presented with pus filled lesions over his left shoulder, axilla and left elbow for last 4 months. Initially, it was a painless pea-sized lesion, which gradually enlarged to form a larger lesion with central ulceration and peripheral extension. He had consulted a couple of doctors and took multiple courses of antibiotics, which had failed to comfort him of the lesions. Cutaneous examination revealed a well‑defined large plaque, sized 16×14cm over the left shoulder extending to the axilla with few pustules, which had erythematous base with serous-purulent discharge. The plaque was nontender and ulcerated, with uneven surface, elevated edges and yellowish crust. There was a similar smaller (sized 5×3cm) plaque over the left elbow. Colonoscopy was not suggestive of either Crohn’s disease or ulcerative colitis. Histopathological examination revealed pseudoepitheliomatous hyperplasia and upper dermal abscesses with predominantly neutrophilic infiltrate. He was further started on prednisolone 40mg once a day in the morning hours after breakfast along with antibiotic for 10 more days. Corticosteroid was tapered by 10mg every 10 days and 10mg was given for a period of 1 month. Resolution of vegetating granulation tissue was observed within 10 days month and complete remission in 1 month. It is very essential to be familiar with PV, as correct diagnosis may reveal an underlying inflammatory bowel disease.