Superficial Granulomatous Pyoderma Research Articles

Multiple vegetative lesions revealing superficial granulomatous pyoderma

Multiple vegetative lesions revealing superficial granulomatous pyoderma

Superficial Granulomatous Pyoderma Successfully Treated with Intravenous Immunoglobulin.

Superficial granulomatous pyoderma is a rare variant of pyoderma gangrenosum.Histopathological and clinical characteristics of superficial granulomatous pyoderma are distinct from those of classic pyoderma gangrenosum.Superficial granulomatous pyoderma is often slow-growing and is only rarely linked to underlying systemic disease.IVIg may be an effective treatment option for superficial granulomatous pyoderma.

Two-Year Delayed Healing of an Endovascular Access Site Related to an Unusual Etiology

In this case report, the authors describe a patient who underwent an endovascular abdominal aortic aneurysm repair complicated by more than a 2-year delay in healing of the left inguinal fold access site. Providers initially suspected a chronic infection or foreign body reaction, but eventually the patient was diagnosed with superficial granulomatous pyoderma. Once the correct etiology was determined and appropriate treatment begun, the access site healed within 3 weeks.

A perplexing case of superficial granulomatous pyoderma with sporotrichoid-like distribution

Superficial granulomatous pyoderma (SGP) is a rare pyoderma gangrenosum (PG) variant that differs from classic PG in that the ulcers tend to be more superficial, lack a rapidly advancing border, and are not typically associated with an underlying systemic disease. The ulcers are most commonly painless and located on the trunk, with a clean granulating base. They generally do not show undermining but may have a vegetative border. Lesions usually respond well to either topical or intralesional corticosteroids with complete healing. The classic histopathologic finding is a "three-layer granuloma" in the superficial dermis consisting of central neutrophilic inflammation and necrosis, a surrounding layer of histiocytes and multinucleated giant cells, and an outer most layer of plasma cells and eosinophils. Herein, we present a unique case of SGP with sporotrichoid-like distribution on the lower extremity.

A case of superficial granulomatous pyoderma successfully treated with intravenous immunoglobulins and systemic corticosteroids

A case of superficial granulomatous pyoderma successfully treated with intravenous immunoglobulins and systemic corticosteroids

Granulomatosis and Polyangiitis Presenting as Superficial Granulomatous Pyoderma

Superficial granulomatous pyoderma (SGP) is one of four subtypes of pyoderma gangrenosum (PG), an uncommon neutrophilic dermatosis, that presents as superficial, indolent ulcerative nodules or plaques that arise independently from an associated underlying disease [1]. Granulomatosis and polyangiitis (GPA) is a systemic, cytoplasmic ANCA (cANCA) positive vasculitis of small and medium vessels classically presenting with a triad of vascular, pulmonary, and renal complications [2]. We report a case of a limited variant of GPA presenting as SGP in a 57- year-old male with multiple nonhealing, painful ulcers on the upper extremities, torso, and neck with histologic features of superficial ulcers with predominantly plasma cell infiltrate consistent with atypical SGP. Over the following year, violaceous ulcers appeared, and a larger wedge biopsy demonstrated sinus tract formation with underlying plasmocytosis with histiocytes and giant cells, neutrophilic inflammation, and focal granuloma formation without vasculitis. The patient developed pulmonary symptoms and fever in the setting of markedly elevated cANCA. A chest CT revealed a lung nodule with fine needle aspiration (FNA) demonstrating acute and granulomatous inflammation but no organisms. Based on compatible clinical and histological findings, the diagnosis of GPA presenting as SGP was established. This case of a variant of GPA initially limited to the integument and mistaken for SGP characterizes the clinical and histopathological presentations of two rare diseases and supports the notion that GPA should be included in the differential diagnosis for SGP even before systemic symptoms and elevated cANCA arise to ensure early diagnosis and treatment.

Superficial granulomatous pyoderma in a patient with ulcerative colitis successfully treated with cyclosporine A

Superficial granulomatous pyoderma in a patient with ulcerative colitis successfully treated with cyclosporine A

Superficial granulomatous pyoderma with eye and lung involvement in a patient with multiple sclerosis.

Superficial granulomatous pyoderma with eye and lung involvement in a patient with multiple sclerosis.

Conservative management of superficial granulomatous pyoderma gangrenosum with oral doxycycline

Conservative management of superficial granulomatous pyoderma gangrenosum with oral doxycycline

Facial Ulceration in a Patient With Crohn's Disease

Question: A 55-year-old woman with longstanding ileocolonic Crohn's disease presented with a facial lesion. She had previously undergone a total proctocolectomy and end-ileostomy for disease that was refractory to prednisone, 6-mercaptopurine, infliximab, and adalimumab. In 2010, she developed an ulcerating lesion on her face, between the left naris and left upper lip. A biopsy showed dermal neutrophilic infiltration (Figure A), and wound cultures did not demonstrate infection. The lesion worsened despite treatment with certolizumab pegol, topical tacrolimus, and intralesional steroids. The patient was admitted for severe facial pain associated with worsening of the ulcerating lesion. She had no gastrointestinal symptoms. On physical examination, there was a 2 × 2-cm ulcer superior to the left upper lip with a full-thickness defect, through which a tooth could be seen (Figure B). The borders of the ulcer had a raised, violaceous edge overhanging the ulcer bed. What is the diagnosis? Look on page 1258 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Pyoderma gangrenosum (PG) typically involves the lower extremities, but infrequently affects other areas including the face.1Wittekindt C. Luers J.C. Klussmann J.P. et al.Pyoderma gangrenosum in the head and neck.Arch Otolaryngol Head Neck Surg. 2007; 133: 83-85Crossref PubMed Scopus (10) Google Scholar Others have reported improvement with various immunosuppressive agents, anti-tumor necrosis factor (TNF) therapy, and intravenous immunoglobulin (IVIg).2Lachapelle J.M. Marot L. Jablonska S. Superficial granulomatous pyoderma gangrenosum of the face, successfully treated by ciclosporine: a long-term follow-up.Dermatology. 2001; 202: 155-157Crossref PubMed Scopus (36) Google Scholar PG classically exhibits pathergy with any trauma, including surgical manipulation.3Davis J.C. Landeen J.M. Levine R.A. Pyoderma gangrenosum: skin grafting after preparation with hyperbaric oxygen.Plast Reconstr Surg. 1987; 79: 200-207Crossref PubMed Scopus (78) Google Scholar Although biopsy results alone cannot be used to diagnose PG, the histopathology of lesions usually shows significant dermal neutrophilic infiltration with occasional cases showing leukocytoclastic vasculitis (Figure A).2Lachapelle J.M. Marot L. Jablonska S. Superficial granulomatous pyoderma gangrenosum of the face, successfully treated by ciclosporine: a long-term follow-up.Dermatology. 2001; 202: 155-157Crossref PubMed Scopus (36) Google Scholar Our patient presented with full-thickness penetration of the lip secondary to PG that progressed despite treatment with an anti-TNF drug and topical tacrolimus. She was started on a continuous infusion of intravenous cyclosporine in conjunction with corticosteroids. One week after starting cyclosporine, the lesion had partially improved. However, she experienced septic complications necessitating discontinuation of cyclosporine and was thus given 2 doses of IVIg.4Gupta A.K. Shear N.H. Sauder D.N. Efficacy of human intravenous immune globulin in pyoderma gangrenosum.J Am Acad Dermatol. 1995; 32: 140-142Abstract Full Text PDF PubMed Scopus (82) Google Scholar Broad-spectrum antibiotics were also initiated. In addition, she underwent hyperbaric oxygen therapy in preparation for wound closure, to minimize infection and promote angiogenesis.3Davis J.C. Landeen J.M. Levine R.A. Pyoderma gangrenosum: skin grafting after preparation with hyperbaric oxygen.Plast Reconstr Surg. 1987; 79: 200-207Crossref PubMed Scopus (78) Google Scholar Three sutures were used to close the full-thickness defect (Figure C). She improved on these treatment modalities and was discharged on certolizumab pegol, oral corticosteroids, and topical tacrolimus. Four months after presentation, the lesion had completely healed (Figure D). Although most literature cautions against surgical manipulation of PG owing to pathergy, this situation required wound closure to allow the patient to eat, and prevent potential wound seeding from oropharyngeal organisms while on significant immunosuppression. This case of complicated facial PG failing anti-TNF therapy was thus successfully treated using intravenous cyclosporine, IVIg, and hyperbaric oxygen in conjunction with surgical wound closure.

Superficial granulomatous pyoderma accompanied with ulcerative colitis successfully treated with tacrolimus ointment

Superficial granulomatous pyoderma accompanied with ulcerative colitis successfully treated with tacrolimus ointment

Superficial Granulomatous Pyoderma of the Face

A 37 year-old male presented with a 5-year history of recurrent erythematosus, demarcated plaques of the right malar region that underwent progressive suppuration. The lesions evolved into a superficial ulcer with atrophic scarring. Despite treatment with numerous antibiotics, the lesions did not improve. Skin biopsy revealed a non-specific granulomatous folliculocentric reaction. Specific stains and tissue cultures were negative for infectious agents. An exclusion diagnosis of superficial granulomatous pyoderma was made and the patient was treated with use of cyclosporine combined with prednisolone with good response; the lesion healed within 3 months.

Superficial Granulomatous Pyoderma of the Vulva in a Patient Receiving Maintenance Rituximab (MabThera) for Lymphoma

Vulval ulceration can be caused by a wide variety of etiological factors including bacterial and viral infections, granulomatous disorders, and malignancy. Superficial granulomatous pyoderma (SGP) is a variant of pyoderma gangrenosum. It is characterized by localized ulcerative lesions that may be precipitated by surgery. We report a case of vulval SPG in an immunocompromised patient. A 51-year-old woman presented with a 6-week history of severe vulval pain, bleeding, and rapidly progressing ulceration. She had a previous history of relapsed follicular non-Hodgkin lymphoma and was currently receiving regular MabThera (Welwyn Garden City, Hertfordshire, UK). Examination revealed deep ulceration involving the entire vulva and extending into the vagina with areas of necrosis. Histological examination showed ulceration with sparse granulomas and eosinophils. The clinical and histological findings confirmed a diagnosis of SGP. Vulval ulceration in an immunocompromised patient has a broad differential diagnosis. The possibility of a granulomatous condition such as SGP must always be considered.

Superficial Granulomatous Pyoderma: A Case in an 11-Year-Old Girl and Review of the Literature

Superficial granulomatous pyoderma is a rare entity thought to be a variant of pyoderma gangrenosum and is often mistaken for classic pyoderma gangrenosum. Superficial granulomatous pyoderma has mainly been described in adults. We describe a case of Superficial granulomatous pyoderma in an 11-year-old girl and present a review of the literature. Superficial granulomatous pyoderma maintains clinical and histopathologic characteristics distinct from classic pyoderma gangrenosum and has a more favorable prognosis. It is often responsive to conservative treatment.

Pioderma granulomatoso superficial: relato de caso de variante rara do pioderma gangrenoso

Pyoderma gangrenosum is a rare idiopathic skin disease. It affects mainly adults, and only 4% of the cases are diagnosed on children and adolescents. There are four clinical forms of pyoderma gangrenosum: ulcerative, pustular, bullous, and vegetative (superficial granulomatous pyoderma). Superficial granulomatous pyoderma is considered the most benign and uncommon form of the disease. Patients who have undergone surgical procedures may occasionally present pyoderma gangrenosum manifestations on the surgical site. A case of a five-year-old child, victim of burn, who presented superficial granulomatous pyoderma on the skin graft donor sites is reported.

Superficial granulomatous pyoderma treated preoperatively with infliximab

We report a case of superficial granulomatous pyoderma (SGP) treated successfully with infliximab. A 71-year-old woman developed erythema, erosions and cribriform scarring in the right periorbital area following enucleation of the right eye. Histology showed three-layered granulomas typical of SGP. The patient's disease was unusual in that it failed to respond to a wide variety of immunosuppressants and this condition is rarely reported to affect the face. Eventually she was treated successfully with infliximab, enabling her to undergo extensive surgery despite the fact that her disease was pathergic in onset.

Superficial granulomatous pyoderma: successful treatment with minocycline

Journal of the European Academy of Dermatology and VenereologyVolume 20, Issue 9 p. 1134-1135 Superficial granulomatous pyoderma: successful treatment with minocycline V Sanchez García, V Sanchez García Departments of Dermatology andSearch for more papers by this authorA Sanz Trelles, Corresponding Author A Sanz Trelles Pathology, Carlos Haya Hospital. Málaga. Spain. *Corresponding author, Servicio de Dermatología, Hospital Civil, Pza Hospital Civil s/n, 29009 Málaga, Spain, tel. +34 661488266; fax +34 951030302; E-mail: virginiapsg@hotmail.comSearch for more papers by this author V Sanchez García, V Sanchez García Departments of Dermatology andSearch for more papers by this authorA Sanz Trelles, Corresponding Author A Sanz Trelles Pathology, Carlos Haya Hospital. Málaga. Spain. *Corresponding author, Servicio de Dermatología, Hospital Civil, Pza Hospital Civil s/n, 29009 Málaga, Spain, tel. +34 661488266; fax +34 951030302; E-mail: virginiapsg@hotmail.comSearch for more papers by this author First published: 03 August 2006 https://doi.org/10.1111/j.1468-3083.2006.01625.xCitations: 12Read 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 onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume20, Issue9October 2006Pages 1134-1135 RelatedInformation

Facial Superficial Granulomatous Pyoderma Treated with Cyclosporin: Not Always a Benign Condition

Facial Superficial Granulomatous Pyoderma Treated with Cyclosporin: Not Always a Benign Condition

Superficial granulomatous pyoderma associated with chronic osteomyelitis

Superficial granulomatous pyoderma associated with chronic osteomyelitis

Pyoderma granulomateux superficiel

Superficial granulomatous pyoderma is a rare variant of pyoderma gangrenosum, which is often diagnosed at a late stage because of misleading clinical-histopathological features. We report a new case of this rare disease. A 67 year-old man presented with inflammatory lesions that had become ulcerated over the past 4 months despite prolonged antibiotic therapy. The histopathological aspect was initially suggestive of palisading granuloma annulare and subsequently a necrotizing granuloma compatible with a mycobacteriosis. The various supplementary examinations eliminated the possibility of an infectious or systemic disease. The lesions became painful and ulcerated. A second biopsy showed a neutrophilic dermatosis with dermal necrosis and a granuloma leading to the diagnosis of superficial granulomatous pyoderma. The lesions healed after 3 months of systemic corticosteroids at the dose of 1 mg/kg/day. The clinical features of superficial granulomatous pyoderma are similar to those of classical pyoderma gangrenosum. However, its histological profile is more superficial and is associated with dermal granulomas. The latter are unusual in neutrophilic dermatosis and would suggest an infectious disease. This explains the frequent diagnostic errors, with inappropriate anti-infectious treatments and notably unnecessary surgical exeresis.