Pyoderma Gangrenosum-like Ulcers Research Articles

Metagenomics assists in the diagnosis of a refractory, culture-negative pyoderma gangrenosum-like ulcer caused by Helicobacter cinaedi in a patient with primary agammaglobulinemia

Helicobacter cinaedi is known to cause various infections in immunocompromised hosts ranging from skin lesions to disseminated septicemia. Identification of H. cinaedi is difficult through conventional identification methods due to its fastidious nature. We reported a refractory and culture-negative pyoderma gangrenosum-like ulcer caused by H. cinaedi in a patient with primary agammaglobulinemia. Metagenomic next-generation sequencing (mNGS) was applied for the identification of H. cinaedi and prolonged minocycline and amoxicillin-clavulanate potassium was used to eradicate the infection. Given the difficulties in culturing this organism, it's highly possible that H cinaedi infections have been overlooked. We suggest that early consideration of H. cinaedi infection should be suspected in immunocompromised patients presenting with unexplained skin lesions as the appropriate antibiotic choice plus a prolonged treatment course is essential for the prognosis. Application of mNGS could contribute to the early identification of rare and cryptogenic pathogens.

Pyoderma gangrenosum-like ulcers or pyoderma gangrenosum associated with antineutrophil cytoplasmic antibody-associated vasculitis.

We read with interest the report by Shakshouk et al. discussing cutaneous ulcers in setting of ANCA associated vasculitis (AAV). These ulcers were diagnosed as pyoderma gangrenosum (PG)-like ulcers, and authors aimed to differentiate these from classical PG. Characteristics of PG-like ulcers in association with AAV remain obscure, and differentiation from PG is not only challenging but perhaps also unnecessary.

Pyoderma gangrenosum-like ulcers over the face in a case of granulomatosis with polyangiitis.

International Journal of DermatologyEarly View Correspondence Pyoderma gangrenosum-like ulcers over the face in a case of granulomatosis with polyangiitis Karthick Kanan MBBS, Karthick Kanan MBBS Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, IndiaSearch for more papers by this authorThoyyib P Karat MBBS, Thoyyib P Karat MBBS Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, IndiaSearch for more papers by this authorVikarn Vishwajeet MD DNB DM, Vikarn Vishwajeet MD DNB DM Department of Pathology, All India Institute of Medical Sciences, Jodhpur, IndiaSearch for more papers by this authorYamini Wadhwa MD, Yamini Wadhwa MD Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, IndiaSearch for more papers by this authorSuman Patra MD, DNB, Corresponding Author Suman Patra MD, DNB [email protected] orcid.org/0000-0003-3764-4283 Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, IndiaSearch for more papers by this author Karthick Kanan MBBS, Karthick Kanan MBBS Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, IndiaSearch for more papers by this authorThoyyib P Karat MBBS, Thoyyib P Karat MBBS Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, IndiaSearch for more papers by this authorVikarn Vishwajeet MD DNB DM, Vikarn Vishwajeet MD DNB DM Department of Pathology, All India Institute of Medical Sciences, Jodhpur, IndiaSearch for more papers by this authorYamini Wadhwa MD, Yamini Wadhwa MD Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, IndiaSearch for more papers by this authorSuman Patra MD, DNB, Corresponding Author Suman Patra MD, DNB [email protected] orcid.org/0000-0003-3764-4283 Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, IndiaSearch for more papers by this author First published: 17 October 2022 https://doi.org/10.1111/ijd.16456 Conflict of interest: None declared. Funding source: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Infections With Enterohepatic Non-H. pylori Helicobacter Species in X-Linked Agammaglobulinemia: Clinical Cases and Review of the Literature.

The genus Helicobacter is classified into two main groups according to its habitat: gastric and enterohepatic. Patients with X-linked agammaglobulinemia (XLA) appear to be associated with invasive infection with enterohepatic non-Helicobacter pylori species (NHPH), mainly H. cinaedi and H. bilis. Such infections are difficult to control and have a high potential for recurrence. The spectrum of illnesses caused by these species includes recurrent fever, bacteremia, arthritis, osteomyelitis, cellulitis, abdominal abscesses, and pyoderma gangrenosum-like ulcer. The presence of these Helicobacters is particularly difficult to diagnose and eradicate, as they are very fastidious bacteria and present resistance to several types of antibiotics. We report two clinical cases of XLA patients infected with H. bilis. These infections were chronic in these patients and could not be eradicated in one of them. We also review the cases of enterohepatic non-Helicobacter pylori species (NHPH) in patients with this inborn error of immunity.

Cutaneous Manifestations of Granulomatosis with Polyangiitis: A Case Series Study.

The aim of this study was to determine the prevalence and type of cutaneous manifestations which occur in patients with granulomatosis with polyangiitis and to explore the potential association between cutaneous and systemic involvement in these patients. A retrospective case series study was designed, including all granulomatosis with polyangiitis cases diagnosed between 2010 and 2018 at the Hospital Universitario Virgen de las Nieves. Thirty-nine patients with granulomatosis with polyangiitis were identified, of which 53.85% presented cutaneous manifestations. In decreasing order of frequency, the types of cutaneous problems observed included: palpable purpura, mucocutaneous ulcers, subcutaneous nodules, pyoderma gangrenosum-like ulcers, digital necrosis, papulonecrotic lesions and livedo reticularis. Patients with palpable purpura presented a higher frequency of renal involvement (p = 0.008). Cutaneous manifestations of granulomatosis with polyangiitis may facilitate early disease diagnosis. Likewise, a manifestation such as palpable purpura may be a predictor of kidney damage.

Saddle-nose and bilateral cauliflower ear deformities with pyoderma gangrenosum-like ulcers, cavitary pulmonary lesions, digital gangrene and pulselessness in a young female

We report a young female who presented with saddle-nose and bilateral cauliflower ear deformities along with pyoderma gangrenosum-like ulcers, digital gangrene and pulselessness. Subsequently, she was found to have bilateral...

Large pyoderma gangrenosum-like ulcers: a rare presentation of granulomatosis with polyangiitis.

Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis (WG), is a rare systemic vasculitis that classically manifests as necrotizing granulomas of the upper and lower respiratory tract, kidneys, and blood vessels; however, it may affect any organ system, including the skin. Cutaneous manifestations occur in up to 45% of patients during the disease course, and are the presenting feature in 9% to 14% of patients. The most common skin lesion specific to GPA is palpable purpura, with the histopathologic correlate of leukocytoclastic vasculitis. However, a wide range of clinical and histologic features may be seen. We herein report a case of a previously healthy 52-year-old Caucasian man who presented with multiple progressively enlarging painful ulcers on his face, upper extremities, back, and abdomen over a two-month period. Skin biopsies revealed pyoderma gangrenosum-like features. Serological tests were positive for PR3/c-ANCA. Six months later, the patient developed recurrent episodes of sinusitis associated with nasal bleeds and eventually nasal septum perforation. Despite aggressive treatment with Cyclophosphamide and steroids over one year, the patient had persistent nonhealing large ulcers and developed multiple lung nodules with cavitary lesions.

Cutaneous Manifestations and Comorbidities in 60 Cases of Takayasu Arteritis

To the Editor: Takayasu arteritis (TA) is a rare chronic vascular inflammatory disease that affects predominantly the aorta and its main branches, in addition to coronary arteries and pulmonary arteries. TA mainly affects young women, especially in the second and third decades of life; it has a high prevalence in Asian countries. The true incidence and prevalence of TA is probably underestimated and many patients remain undiagnosed or wait a long time before the correct diagnosis is made1. TA is typically presented in 2 stages: a “prepulseless” stage and a “pulseless” stage. In the former there are malaise, fever, myalgias, arthralgias, and weight loss. In this stage it may be difficult to differentiate TA from other rheumatic and collagen diseases. In the second stage, complications related to large arterial stenosis and aneurysm formation predominate. The 2 stages may overlap or occur out of sequence. In both stages, cutaneous manifestations may be present, such as inflammatory nodules, erythema nodosum, and pyoderma gangrenosum-like ulcers, and more rarely, purpura2. Eventually, cutaneous manifestations may be present as an initial signal of TA3. We systematically reviewed 60 patients with TA as proposed by the 1990 American College of Rheumatology (ACR) classification4, further delineating the prevalence and cutaneous manifestations observed in these cases. Three patients with specific TA cutaneous manifestations are described in detail. Our study was a single-center transversal study. From March 2010 to April 2012, 87 consecutive patients with TA were followed at our service. All patients fulfilled at least 3 of the 6 ACR criteria for the classification of TA, as proposed by Arend, et al 4. All these patients were invited for our evaluation, and 60 showed up. A dermatologist in the dermatology department of our hospital examined these 60 patients. Medical data … Address correspondence to Dr. L. Rocha, Hospital das Clínicas da Faculdade de Medicina da USP – Dermatology, Av. Dr. Enéas de Carvalho, 500 São Paulo, São Paulo 05409-000, Brazil., E-mail: lilianrocha{at}me.com

Helicobacter spp. Other than H. pylori

Significant advances have been made over the last 12 months in the understanding of the biology of non-H. pylori Helicobacter species (NHPH). Several studies have investigated the association between NHPH and human disease, including Crohn's disease, lithiasis, liver disease, coronary disease, gastritis, and pyoderma gangrenosum-like ulcers. Novel Helicobacter taxa were identified in new vertebrate hosts, and new methodologies in the fields of identification of Helicobacter spp. and evaluation of antibiotic resistance were described. The genome of the first human-derived gastric NHPH strain (Helicobacter bizzozeronii CIII-1) was sequenced, and several studies elucidated functions of different genes in NHPH. A number of important investigations regarding pathogenesis and immunopathobiology of NHPH infections have been published including the description of a new urease in Helicobacter mustelae. Finally, the effects of the gut microbiota and probiotics on NHPH infections were investigated.

Pyoderma gangrenosum-like ulcer caused by Helicobacter cinaedi in a patient with x-linked agammaglobulinaemia

Cutaneous lesions of the legs have been linked to Helicobacter species in a number of patients with X-linked agammaglobulinaemia (XLA), a primary immunodeficiency. We describe a 26-year-old patient with XLA, who was referred with an extensive skin ulcer that enlarged gradually over the course of 7 years. The ulcer resembled pyoderma gangrenosum (PG), and extended from below the knee to the ankle. The man (who has sex with men) was negative for human immunodeficiency virus. Helicobacter cinaedi was identified by 16S ribosomal (r)DNA PCR analysis from a biopsy of the lesion. This fastidious organism has been implicated previously in causing unexplained skin macules in one other patient with XLA. We suggest that early consideration of infection with Helicobacter species in immunocompromised patients who present with unexplained cutaneous lesions is important, as a prolonged antibiotic course can lead to clinical improvement.

Sunitinib induced pyoderma gangrenosum-like ulcerations

Pyoderma gangrenosum is a non-infectious neutrophilic skin disease commonly associated with underlying systemic diseases. Histopathological and laboratory diagnostics are unspecific in the majority of the cases and the diagnosis is made in accordance with the clinical picture. Here, we report the case of a 69-year old man with progredient pyoderma gangrenosum-like ulcerations under treatment with sunitinib due to hepatocellular carcinoma. A conventional ulcer therapy did not lead to a regression of the lesions. Solely cessation of sunitinib therapy resulted in an improvement of the ulcerations. Sunitinib is a multikinase inhibitor that targets the PDGF-α - and -β-, VEGF-1-3-, KIT-, FLT3-, CSF-1- and RET-receptor, thereby impairing tumour proliferation, pathological angiogenesis and metastasation. Here, we demonstrate that pyoderma gangrenosum-like ulcers may represent a serious side effect of sunitinib-based anti-cancer treatment.

Pyoderma gangrenosum-like ulcer in a patient with large granular lymphocytic leukemia

Large granular lymphocytic leukemia refers to a clonal expansion of lymphocytes that have abundant cytoplasm and azurophilic granules. The disease is characterized clinically by chronic neutropenia and it may be associated with recurrent pyogenic infections. Except for these infections, cutaneous manifestations of this disease have not been well characterized. We describe a patient with large granular lymphocytic leukemia, which was confirmed by molecular genetics studies, who had a pyoderma gangrenosum-like ulcer on his leg. Results of an evaluation of the histologic characteristics and the leukocytic immunophenotype of a skin biopsy specimen from the ulcer demonstrated large granular lymphocytes within the blood vessels. Cutaneous ulceration may be a manifestation of large granular lymphocytic leukemia, and this disease should be considered when diagnosing patients with otherwise unexplained pyoderma gangrenosum-like ulcers of the skin.