Case Of Pyoderma Gangrenosum Research Articles

A Case of Pyoderma Gangrenosum During Nivolumab Treatment for Right Upper Lobe Lung Cancer

A Case of Pyoderma Gangrenosum During Nivolumab Treatment for Right Upper Lobe Lung Cancer

A Case of Pyoderma Gangrenosum with Lung Involvement Misdiagnosed as Necrotizing Fasciitis

A Case of Pyoderma Gangrenosum with Lung Involvement Misdiagnosed as Necrotizing Fasciitis

Long-term remission achieved in a rare case of pyoderma gangrenosum and ulcerative colitis with surgery and postoperative infliximab.

Background Pyoderma gangrenosum (PG) is a rare extraintestinal manifestation of inflammatory bowel disease. In recent years, the use of biologics in PG has been on the rise and has shown promising results. The surgical treatment of PG remains a topic of debate, with limited reports on the use of postoperative biologic therapy. Case reprt: This case report describes a 52-year-old woman who presented with multiple skin ulcers, pus discharge, and bloody diarrhea. The patient was diagnosed with PG with ulcerative colitis based on medical history, ulcer appearance, histopathology, treatment response, and the presence of ulcerative colitis. Surgical intervention was performed to repair the ulcers and amputate the fourth finger and fourth toe of both feet. Additionally, infliximab induction therapy was initiated two weeks after the surgery. The patient's intestinal symptoms demonstrated improvement, and after 10 months of treatment, the lesions were completely healed with no recurrence of skin ulcers. Conclusions This case report highlights a rare instance of successful treatment for PG with ulcerative colitis through a combination of surgery and postoperative infliximab.

Dapsone Associated Methemoglobinemia-----A Case of Blue Discoloration:

Dapsone is among the medicine that belongs to sulfone groups and being used to treat leprosy and dermatitis. It inhibits the synthesis of dihydrofolic acid by competing with para-aminobenzoic acid. This is a case of a lady in her mid70's known case of pyoderma gangrenosum recently started on dapsonepresented to ED with complaint of shortness of breath, discoloration of fingers for 4days. Patient had saturation of 88% room air. Relevant examination showed blue discoloration of the finger pulps. Arterial blood gas analysis showed oxygen saturation of 98%RA and PaO2 of 87mmHg, suggestive of positive saturation gap. She was treated with IV methylene blue on the impression of methemoglobinemia and her discoloration improved rapidly. An approach to hypoxia in ED must be considered in context of saturation gap in patients suspected of having toxicological cause. Methemoglobinemia treatment requires methylene blue administration that causes rapid resolution of symptoms.

A case of pyoderma gangrenosum associated to bevacizumab, angiogenesis role in its etiology

A case of pyoderma gangrenosum associated to bevacizumab, angiogenesis role in its etiology

Surgical Treatment of Pyoderma Gangrenosum with Negative Pressure Wound Therapy and Dermal Substitutes: A Case Report

Pyoderma gangrenosum is a rare ulcerative skin lesion that occurs primarily on the lower extremities for which surgical debridement and skin grafting have been traditionally contraindicated. However, recent literature has reported favorable results from surgical treatment of lesions with adequate immunosuppressive therapy. We report a case of pyoderma gangrenosum with a local infection in a 58-year-old man’s leg that showed improvement in symptoms within a relatively short period, through surgical treatment using negative pressure wound therapy and a dermal substitute. The authors report this case with a literature review.

A clinical case of pyoderma gangrenosum as a severe extraintestinal manifestation of Crohn’s disease

Pyoderma gangrenosum is a rare neutrophilic dermatosis associated with a number of immune-mediated disorders, most frequently with inflammatory bowel disease and rheumatoid arthritis. Despite significant success in the treatment in inflammatory bowel disease, the problem of multidisciplinary management of patients with extraintestinal manifestations in routine medical practice remains unsolved. The paper presents a clinical case of a 32-year old female patient with a life-threatening extraintestinal manifestation of Crohn's disease, i. e. pyoderma gangrenosum. Late diagnosis of Crohn's disease, underestimation of the inflammation activity in the gut and respective lack of disease-modifying treatment were the reasons for the occurrence of pyoderma gangrenosum and its uncontrolled course. The untimely diagnosis of the skin purulent wound as an extraintestinal manifestation of Crohn's disease has led to delay in the immunosuppressive therapy required. The patient needed an intensive course of systemic glucocorticosteroids, prompt addition of a tumor necrosis factor-alpha inhibitor and surgery as a circulatory autodermoplasty.

Recalcitrant Pyoderma Gangrenosum: Clinical Burden and Unmet Needs.

Pyoderma gangrenosum (PG) is a rare, autoinflammatory disease leading to aseptic ulcers which carries a significant disease burden and is often difficult to treat, with many patients failing first-line treatment and requiring additional therapies. Such cases are typically referred to in the literature as "recalcitrant", "refractory", or "resistant", though little is known about the clinical characteristics of such cases. We performed a narrative literature review to characterize patient demographics and clinical course associated with difficult to treat pyoderma gangrenosum cases in order to identify trends to guide future clinical management and therapeutic innovation. We identified 148 cases with clinical manifestations and associated patient demographics stratified by ulcer and patient features. Consistent with previous work, a greater prevalence of PG was observed among female patients and those with a history of inflammatory bowel disease, however interestingly despite an aggressive course to their PG, few patients had comorbidities complicating their disease course. Additionally, despite the requirement of three or more treatments for most patients' disease to resolve, the majority healed within the typical window observed in previous clinical studies with low rates of recurrence. Biologics were the most common medication patients were on at time of remission. Collectively, our results suggest a potential benefit for a reduced threshold for biologic initiation in PG patients and a need for standardization of language in the field to facilitate treatment outcomes comparisons and interventions.

Disseminated Necrotic Suppurative Ulcers as a Manifestation of Cocaine Abuse.

Pyoderma gangrenosum is an immune-mediated illness that can be caused by several affections, such as inflammatory bowel disease, rheumatoid arthritis, and drug use. We present a rare case of pyoderma gangrenosum induced by levamisole-adulterated cocaine. There have been few cases of this disease reported in the world. Levamisole is an anthelmintic drug used to adulterate cocaine to boost its effect. It also has immune-modulating effects causing, among others, vasculitis and dermatological problems. Clinical case of a 46-year-old man admitted to the hospital University Marqués de Valdecilla in Santander, Spain, in August 2022. We diagnosed pyoderma gangrenosum based on clinical, analytical, and histological parameters. We report a case of pyoderma gangrenosum induced by consumption of levamisole-adulterated cocaine. This patient suffered from a rare and extensive immune-mediated affection with characteristic primary lesions in the form of suppurative ulcers that responded to immunosuppressive treatment. Behind pyoderma gangrenosum there may be underlying conditions such as inflammatory bowel disease, or pyoderma gangrenosum may be secondary to identifiable causes such as cocaine use as in this patient. Pyoderma gangrenosum induced by levamisole-adulterated cocaine has the following features:History of cocaine use.Exaggerated skin injury occurring after minor trauma (pathergy).Characteristic histopathologic findings.

PIODERMA GANGRENOSUM ABOUT A CASE

Pyoderma gangrenosum is an inflammatory skin disease characterized by the formation of deep, painful ulcers that may heal with prominent scarring. This condition is classified as a neutrophilic disorder, which means it involves an exaggerated response from immune cells called neutrophils. Next, we will describe a clinical case of pyoderma gangrenosum that illustrates the typical characteristics of this disease. For its diagnosis, it was important to perform a biopsy of the lesions and their treatment. It is important to keep in mind that the disease can affect not only the physical health of the patient, but also her mental and emotional health.

Successful management of recurrence of lung surgery-induced pyoderma gangrenosum after pacemaker implantation: a case report

BackgroundPyoderma gangrenosum begins as a painful erythema with induration, vesicles, or hemorrhagic pustules, which develops into serous ulcers. In addition to ulcerative colitis and myelodysplastic syndrome, surgical intervention may also induce this disease.Case presentationA 90-year-old man had previously undergone video-assisted thoracic surgery left upper lobectomy for left lung cancer. Blood tests on the 6th postoperative day showed elevated levels of white blood cells and C-reactive protein. The wound appeared red and drained pus; however, the wound culture was negative for bacteria. A skin biopsy was performed on the 13th postoperative day, and the patient was diagnosed with pyoderma gangrenosum. Tacrolimus hydrate ointment was administered, symptoms gradually improved around the 18th postoperative day, and the erythematous area shrank. The patient was discharged on the 50th postoperative day.Six months after lung surgery, a pacemaker was implanted in the left subclavian region. On the 6th postoperative day, the wound appeared reddish-brown and exudate was observed. On the 10th postoperative day, wound dehiscence was observed, and the pacemaker was removed. The patient was diagnosed with recurrent pyoderma gangrenosum and was re-treated with ointment. On the 29th postoperative day, a leadless pacemaker, which can be implanted with a small incision, was selected for treating arrhythmia. The patient was discharged 7 days after the second implantation.ConclusionWe report a recurrent pyoderma gangrenosum case following lung cancer surgery after pacemaker implantation as the second surgery, in which disease recurrence could be prevented by changing to a leadless pacemaker. Surgery and other invasive procedures should be avoided in pyoderma gangrenosum patients.

A case of pyoderma gangrenosum in a cesarean section wound that was difficult to distinguish from wound infection

A case of pyoderma gangrenosum in a cesarean section wound that was difficult to distinguish from wound infection

Case Report and Literature Review: A Severe Case of Pyoderma Gangrenosum Approached with Regenerative Medicine

Pyoderma gangrenosum (PG) is a challenging autoinflammatory neutrophilic dermatoses (ND) condition characterized by painful skin alterations leading to ulceration and tissue necrosis. Regenerative medicine (RG) offers promising strategies for addressing these challenges. Diverse therapies including mesenchymal stem cells (MSC), MSC-exosomes, tilapia skin grafts with fibroblast growth factors (FGF), and antioxidants like Vitamin C (VitC), have demonstrated effectiveness in promoting wound healing, reducing inflammation, and restoring tissue function. This paper offers comprehensive insights into the pathogenesis, epidemiology, and conventional treatment approaches for PG, while also providing a concise review of pertinent RM therapies. In this case report, a severe case of PG is managed with a combination of RM therapies, with remarkable results. A 73-year-old patient experienced persistent ulceration, pain, and edema despite conventional treatments. The administration of IV (Intravenous) MSCs, MSC-exosomes, tilapia skin graft, FGF, and VitC resulted in significant improvement in wound healing, pain reduction, and inflammation control. This case demonstrates the potential use of RM therapies in managing complex dermatological conditions like PG. The integration of regenerative approaches provides hope for patients with challenging conditions, potentially leading to enhanced outcomes and reduced recovery times. As PG remains a difficult-to-treat condition, RM holds promise as a valuable alternative therapy option for patients facing these severe dermatoses conditions.

In-hospital mortality in a dermatology department

Background: Far from popular belief making dermatological conditions benign and harmless, we know that some dermatoses may be life-threatening. The aim of our study was to evaluate the overall mortality resulting from dermatological disorders in our department because of the rarity of similar studies. Materials and Methods: We conducted a retrospective, observational study on all patients who died in the Ibn Sina Hospital of Rabat between January 2017 and December 2021 (a period of five years), after they were initially admitted to the dermatology department. Results: Among 1731 patients hospitalized during this period, 45 died, corresponding to an average of 2.6%. The male-to-female ratio was 1.9 and the mean age at death was 63.2 years. The mean number of comorbidities per patient was 1.2, dominated by diabetes. The reasons for hospitalization were as follows: twenty-three cases of extensive bullous dermatoses (60.5% of the cases), four cases of severe toxidermia (10.5%), three cases of erythroderma (7.8%), one case of acro-lentiginous melanoma, one case of squamous cell carcinoma, and one case of pyoderma gangrenosum. In twenty patients (52.6%), the cause of death was directly related to the dermatosis. In sixteen, the cause of death was septic shock of cutaneous origin. Sixteen patients (42.1%) died of causes unrelated to dermatosis. Conclusion: This study showed that life-threatening dermatoses are not uncommon. Among these conditions, autoimmune bullous dermatoses and severe toxidermia, such as TEN and DRESS syndrome, were found to be the most lethal. An advanced age, a surface area of skin involvement, mucosal involvement, associated comorbidities, and the development of sepsis may be considered poor prognostic factors.

Rituximab and Pyoderma Gangrenosum: An Investigation of Disproportionality Using a Systems Biology-Informed Approach in the FAERS Database.

Studies have found an increased risk of pyoderma gangrenosum associated with rituximab. The structural properties and pharmacological action of rituximab may affect the risk of pyoderma gangrenosum.Additionally, pyoderma gangrenosum is associated with autoimmune disorders for which rituximab is indicated. We aimed to determine whether rituximab is disproportionally associated with pyoderma gangrenosum using a systems biology-informed approach. Adverse eventreports were extracted fromthe US Food and Drug Administration Adverse Event Reporting System (FAERS,2013-20).The Bayesian Confidence Propagation Neural NetworkInformation Component was usedto test fordisproportionality. Comparators usedto determinepotentialcausal pathways included all other medicines, all medicines with a similar structure (monoclonalantibodies), allmedicines with the same pharmacological target (CD20 antagonists)and all medicines used for the sameindication(s) as rituximab. Thirty-twopyoderma gangrenosum caseswere identified, 62.5% were female, with a median age of 48 years.There was an increasedassociation of pyoderma gangrenosum with rituximabcompared with all other medicines(exponentiated Information Component 6.75,95% confidence interval(CI) 4.66-9.23). No association was observed when the comparator was either monoclonal antibodies or CD20 antagonists. Conditions for which an association of pyoderma gangrenosum with rituximab was observed weremultiple sclerosis(6.68,95% CI1.63-15.15), rheumatoid arthritis(2.67,95% CI 1.14-4.80) and non-Hodgkin's lymphoma (2.94, 95% CI 1.80-3.73). Pyoderma gangrenosumwas reported more frequently with rituximab compared with all other medicines. The varying results when restricting medicines for the same condition suggest the potential for confounding by indication. Post-market surveillance ofbiologic medicinesin FAERS should consider a multi-faceted approach, particularly when the outcome of interest isassociated with the underlying immune condition being treated by themedicine of interest.

Pyoderma gangrenosum in a patient with metastatic breast cancer

Pyoderma gangrenosum is a cutaneous ulcer diagnosed by exclusion. The underlining causes of pyoderma gangrenosum are numerous. Malignancy is a well-known underlying cause. Nonetheless, breast cancer is an uncommon cause, with few reported cases in the literature. There is no specific treatment of paraneoplastic pyoderma gangrenosum, apart from treating the underlying malignancy. Herein, we report a case of pyoderma gangrenosum with underlying breast cancer, successfully treated by systemic steroids, although the patient showed no response to anticancer therapy and expired shortly after the resolution of the cutaneous lesion. Further studies are needed to conclude the benefit of systemic steroids in paraneoplastic pyoderma gangrenosum, yet we recommend a trial of systemic steroids in the case of generalized resistant paraneoplastic pyoderma gangrenosum.

Pyoderma gangrenosum caused by secukinumab successfully treated with risankizumab: a case report and literature review

We report a case of pyoderma gangrenosum (PG) caused by secukinumab, which was successfully treated with risankizumab. We also reviewed reported cases of PG caused by interleukin (IL)-17 inhibitors. The clinical course of this case indicates that IL-23 may play an important role in the pathogenesis of PG and therefore IL-23-targeting therapies may be a treatment option for PG.

A Case of Pyoderma Gangrenosum Complicated with Ulcerative Colitis Successfully Treated by Granulocyte and Monocyte Adsorption Apheresis

A Case of Pyoderma Gangrenosum Complicated with Ulcerative Colitis Successfully Treated by Granulocyte and Monocyte Adsorption Apheresis

Pyoderma gangrenosum mimicking a Buruli’s ulcer in an HIV-positive patient from Ivory Coast

A lower limb ulcer is a disabling disease with significant functional impact and difficulties to manage. Ulcers, due to infectious agents, an inflammatory etiology, or microvascular occlusion are particularly challenging in terms of diagnosis and treatment. The management of such ulcers requires proper clinical examination as well as oriented biological and histological assessments. Herein, we report the case of a 39-year-old female from Ivory Coast with an extensive bilateral lower limb ulcer evoking a Buruli’s ulcer. Investigations, however, revealed a severe case of pyoderma gangrenosum in an HIV-positive patient. Our case report demonstrates the difficulties in the diagnosis of leg ulcers, especially in immunosuppressed patients. Confusing pyoderma gangrenosum with a Buruli’s ulcer may lead to extensive surgery or the use of long-term steroids with multiple iatrogenic complications, hence the importance of a skin biopsy and biological assessments in establishing a correct diagnosis.

DOP32 Biologic treatment does not reduce the risk of postoperative peristomal pyoderma gangrenosum in Crohn’s Disease patients

Abstract Background To assess the risk of postoperative peristomal pyoderma gangrenosum in Crohn’s disease patients undergoing bowel resection with formation of an ostomy. Methods All patients with Crohn’s disease undergoing intestinal resection with formation of an ostomy were included in the present retrospective analysis. The data collection was performed prospectively. All cases of pyoderma gangrenosum were identified by clinical examination and documented on photographs. “Extended colectomies” were total colectomy and proctocolectomy. Results Between 2009 and 2021, 99 patients underwent intestinal resections with formation of an ostomy – 95 ileostomies and 4 colostomies. Ileocolic resections were performed in 62 patients, small bowel resections in 2 and colorectal resections in 35 patients. Additional abdominoperineal rectal resections were performed in 19 out of latter 35 patients. At the time of surgery, 31 patients were on biological treatment, 19 on steroids. Postoperatively, 10 patients (10%) developed peristomal pyoderma gangrenosum – all during first 3 postoperative months and all in presence of an ileostomy. By univariate analysis, abdominoperineal resection (26% vs. 9%, p=0.03), presence of colonic disease (20% vs. 2%, p=0.005), preoperative biological treatment (24% vs. 4%, p=0.008), extended colectomy (27% vs. 5%, p=0.008), non-stricturing/non-penetrating disease (35% vs. 5%, p=0.002) were associated with an increased risk of peristomal pyoderma gangrenosum. By multivariate analysis, preoperative intake of biologic treatment (Hazard Ratio 5.5, p=0.03), and non-stricturing/non-penetrating disease (HR 8.3, p=0.006) were associated with the risk of postoperative pyoderma gangrenosum. Conclusion Crohn’s disease patients with colonic disease undergoing bowel resections for non-stricturing/non-penetrating disease are at high risk to develop peristomal pyoderma gangrenosum during the early postoperative period. Preoperative biological treatment does not decrease the risk of pyoderma formation; moreover, it might even increase it.