Ulcerative Lesions Research Articles

Platelet-derived biomaterial controls aspergillus fumigatus keratitis by decreasing fungal burden: an in vivo study.

Fungal keratitis is a severe corneal infection characterized by suppurative and ulcerative lesions. Aspergillus fumigatus is a common cause of fungal keratitis. Antifungal drugs, such as natamycin, are currently the first-line treatment for fungal keratitis, but their ineffectiveness leads to blindness and perforation. Additionally, the development of fungal resistance makes treating fungal keratitis significantly more challenging. The present study used platelet-derived biomaterial (PDB) to manage A. fumigatus keratitis in the animal model. Freezing and thawing processes were used to prepare PDB, and then A. fumigatus keratitis was induced in the mice. Topical administration of PDB, natamycin, and plasma was performed; quantitative real-time PCR (qPCR) and histopathologic examination (HE) were used to assess the inhibitory effect of the mentioned compounds against fungal keratitis. The qPCR results showed that PDB significantly decreased the count of A. fumigatus compared to the control group (P-value ≤ 5). Natamycin also remarkably reduced the count of fungi in comparison to the untreated animal, but its inhibitory effect was not better than PDB (P-value > 5). The findings of HE also demonstrated that treatment with PDB and natamycin decreased the fungal loads in the corneal tissue. However, plasma did not show a significant inhibitory effect against A. fumigatus. PDB is intrinsically safe and free of any infections or allergic responses; additionally, this compound has a potential role in decreasing the burden of A. fumigatus and treating fungal keratitis. Therefore, scientists should consider PDB an applicable approach to managing fungal keratitis and an alternative to conventional antifungal agents.

Snus Use in Adolescents: A Threat to Oral Health.

Background: Snus consumption is increasingly popular, mainly among the youth, due to the promotion of the tobacco industry and the lack of knowledge regarding its adverse effects. Even though some of its systemic complications are common knowledge, the oral consequences are rarely known. Aim: Therefore, the objective of this study is to evaluate the oral health effects of snus consumption among a highly exposed group of adolescent athletes. Design: Participants received an interactive presentation, followed by interviews and dental screenings by young doctors to establish trust. They were categorized into groups based on the frequency of snus usage. The oral hygiene habits and status, snus consumption habits, and awareness about its adverse effects were evaluated. Results: Statistically significantly (p < 0.05), more regular snus users experience gum bleeding while tooth brushing than nonusers (60% and 37%, p = 0.004). Snus consumption and poor oral hygiene have a cumulative effect on oral health. Some young athletes experience ulcerous oral mucosal lesions coinciding with snus placement. Nonusers exhibit greater awareness of the adverse effects of snus than regular users (27% and 49%). Conclusions: Regular snus use negatively affects oral health, especially the gums. Early education is of the utmost importance in preventing snus usage by raising awareness.

Characterization of the Hoof Bacterial Communities of Active Digital Dermatitis Lesions in Feedlot Cattle.

Digital dermatitis (DD) is a costly hoof infection, causing lameness and pain in feedlot cattle. DD lesions can develop nonlinearly through a series of clinical stages, which can be classified by Dopfer's M-stage scoring system. This widely adopted lesion scoring system recognizes five DD stages, where M1 (early lesion), M2 (acute ulcerative lesion), and M4.1 (chronic proliferative lesion with new developing lesion) are considered active but separate stages of the disease. This study assessed the skin surface microbiota of the active DD lesions of feedlot cattle. The DD lesions from three commercial feedlots were swabbed and then scored according to Dopfer's M-stage scoring system. Swab samples were collected from 12 M2- and 15 M4.1-stage lesions. A total of 21 control swab samples from healthy contralateral feet (DD control) were classified as stage M0. An additional six skin swabs (M0) were collected from completely healthy (CH control) cattle with no lesions. The bacterial communities of active DD lesions (M2 and M4.1) and healthy skin (M0) were profiled using 16S amplicon sequencing. Diversity analyses showed that the hoof bacterial communities of M2 and M4.1 lesions were each distinct from those of M0 skin. However, the bacterial communities between the two active lesion stages were not different from each other. A significant increase in the relative abundance of Spirochaetota and Fusobacteriota and an overall decrease in bacterial diversity contributed to the altered bacterial communities in M2 and M4.1 lesions compared to those of healthy skin (M0). Although stages M2 and M4.1 are considered clinically different stages, the lesion-associated bacterial community is similar between the two active stages.

Immunizing Mice with Influenza Virus-like Particles Expressing the Leishmania amazonensis Promastigote Surface Antigen Alleviates Inflammation in Footpad.

Cutaneous leishmaniasis (CL) is a tropical disease endemic in many parts of the world. Characteristic clinical manifestations of CL include the formation of ulcerative skin lesions that can inflict life-long disability if left untreated. Although drugs are available, they are unaffordable and out of reach for individuals who need them the most. Developing a highly cost-efficient CL vaccine could address this problem but such a vaccine remains unavailable. Here, we developed a chimeric influenza virus-like particle expressing the Leishmania amazonensis promastigote surface antigen (LaPSA-VLP). LaPSA-VLPs were self-assembled in Spodoptera frugiperda insect cell lines using the baculovirus expression system. After characterizing the vaccines and confirming successful VLP assembly, BALB/c mice were immunized with these vaccines for efficacy assessment. Sera acquired from mice upon subcutaneous immunization with the LaPSA-VLP specifically interacted with the L. amazonensis soluble total antigens. LaPSA-VLP-immunized mice elicited significantly greater quantities of parasite-specific IgG from the spleens, popliteal lymph nodes, and footpads than unimmunized mice. LaPSA-VLP immunization also enhanced the proliferation of B cell populations in the spleens of mice and significantly lessened the CL symptoms, notably the footpad swelling and IFN-γ-mediated inflammatory response. Overall, immunizing mice with the LaPSA-VLPs prevented mice from developing severe CL symptoms, signifying their developmental potential.

Spindle cell carcinoma of the lower lip: A case report and review of the literature

To document the lip as an unusual site of clinical presentation of spindle cell carcinoma and to conduct a review of the literature. A 66-year-old male patient presented with an ulcerated lesion of the lower lip. Morphological examination and immunohistochemical profiling of the lesion were performed.

Mangy armadillos: New records of Karethraichnus minimum in extinct quaternary pampatheres of the Brazilian intertropical region

This paper presents pathological lesions in the osteoderms of three extinct pampatheres: two specimens of the genus Holmesina sp. and one specimen of Pampatherium humboldtii, which lived in the Brazilian Intertropical Region. The traces analyzed here were attributed to the ichnospecies Karethraichnus minimum and were associated with the behavior of ectoparasites, such as fleas, likely belonging to the genus Tunga. Some osteoderms also present ulcerative lesions, possibly generated by the action of microorganisms such as bacteria and fungi. These new records expand our knowledge about the paleopathologies caused by fleas in extinct pampatheriids, demonstrating that such occurrences were common.

Clinical management and case review of a presumptive novel clinical presentation of protothecosis in donkeys causing ulcerated nodular lesions in the ear pinnae of 18 animals

AbstractThis is a retrospective case series that describes a novel syndrome seen in 18 donkeys in Morocco that presented to this author,'s clinic with ulcerated nodular lesions of the ear pinnae. In the majority of cases, the lesions are confined to the ears, they are always bilateral and can occasionally progress to other areas of the body. Macroscopically, the lesions in all 18 donkeys are very uniform in presentation, even if the size of the nodules varies. This case series reviews the presentation, investigation, treatment and outcome for 18 cases presented to these authors’ clinics from 2011 to 2021. Skin biopsies from a subset of eight cases showed similar changes in chronic pyogranulomatous, dermatitis with myriad intra‐ and extra‐histiocytic organisms, the morphology of which is most consistent with that of Prototheca spp. infection. This is a novel presentation that represents a significant welfare issue for donkeys, as well as having important economic consequences for owners in the developing world.

Acute ulcerated botryomycosis in an immunocompromised patient

Botryomycosis is a rare chronic granulomatous bacterial infection with approx. 200 reported cases worldwide. The most common microorganism associated with this condition is Staphylococcus aureus. Botryomycosis manifests itself across a spectrum of lesions with a characteristic histological feature known as the Splendore–Hoeppli phenomenon. Herein, we report the case of a 35-year-old female presenting with an ulcerated lesion and a previous diagnosis of lymphoblastic leukemia. Botryomycosis should be considered in immunosuppressed patients with ulcerated lesions. Treatment duration may range from four to eight weeks, with debridement if necessary. It is essential to exclude visceral involvement. Key words: Botryomycosis, Staphylococcus aureus, Lymphoblastic leukemia, Immunosuppression

PRIMARY CUTANEOUS ASPERGILLOSIS IN A 13-YEAR-OLD BOY WITH BONE MARROW APLASIA: CASE REPORT

Cutaneous aspergillosisis a rare condition, and while rare in immunocompetent individuals, it predominantly affects immunosuppressed patients, particularly those with hematological-oncological disorders within the pediatric demographic. Herein, we present a 13-year-old boy under follow-up for bone marrow aplasia. The child developed long-lasting fever and papulous and ulcerous indurated skin lesions on his whole body. Blood count showed agranulocytosis with neutrophils count of 10/μl. Thoracic, abdominal and pelvic Computed Tomography (CT) scan has revealed bilateral alveolar syndrome in the lungs. Skin biopsy revealed cutaneous aspergillosis. Despite treatment, the boys condition did not improve, and he passed away 2 weeks following his hospital admission because of septic shock. Cutaneous aspergillosis is due to Aspergillus flavus and A. fumigatus, for primary and secondary (invasive) cases, respectively. The rapid progression of this disease from the initial cutaneous infectious region necessitates prompt medical intervention to avoid increasing the risk of mortality. This condition typically manifests after the fungus is directly inoculated through skin contact with contiguous infected areas or via hematogenous spread from a remote mycotic site to the skin.

Primary cutaneous extranodal NK/T cell lymphoma, nasal: presentation with ulcerative lesions in lower limbs. A case report

Primary cutaneous extranodal NK/T cell lymphoma, nasal: presentation with ulcerative lesions in lower limbs. A case report

Gastroduodenal injury and repair mechanisms.

Although the mucosal barrier serves as a primary interface between the environment and host, little is known about the repair of acute, superficial lesions or deeper, persistent lesions that if not healed, can be the site of increased permeability to luminal antigens, inflammation, and/or neoplasia development. Studies on acute superficial lesions have been sparse in the past year, with more focus given to novel mechanisms of mucosal protection, and the way in which mature epithelial cells or committed stem cells dedifferentiate, reprogram, proliferate, and then regenerate the gastroduodenal mucosa after injury. For this, adenoviral therapy showed organ specific targeting with mRNA and protein expression of effectors to protect against mucosal injury and ulceration. A large database of plant-based agents known to protect against injury and ulceration was published, along with studies using plant-based compounds delivered with alginates, polysaccharide/gel floating rafts, or incorporated into nanoparticles or green carbon dots to improve targeting and retention at the ulcerated lesion. With RNA technology developing rapidly, particularly single-cell RNA sequencing, important and novel data was forthcoming on mucosal regeneration. In particular, the role of interleukin-17 hub proteins in mucosal healing was highlighted. The presence and role of injury reserve cells was determined, as was the composition of ligand gradients for cell differentiation in both stomach and duodenum. The role of amphiregulin in parietal cell differentiation from lineage-restricted stem cells and the Yap1 gene signature in metaplasia vs. healing ulcers were of particular importance. Additionally, studies unveiled the important role of mesenchymal stromal cells in differentiation and repair mechanisms, in Muse cells as an exciting new therapy for mucosal repair after injury, and the role of sympathetic neurons in activating the immune system to regulate mucosal repair mechanisms. Recent studies highlight novel mechanisms that promote mucosal regeneration after injury of the gastroduodenal mucosa.

A clinical case of non-tuberculosis mycobacterial infection of the lungs and larynx

ABSTRACT. An actual clinical case of the diagnosis and course features of non-tuberculosis mycobacterial infection (NTMI) of the lungs and larynx in a patient treated at the Zaporizhzhia Regional Phthisiopulmonology Clinical Treatment and Diagnostic Center is presented. The clinical case demonstrates the difficulty of differential diagnosis of NTMI of the lung caused by scotochromogenic mycobacterium and tuberculosis, since the clinical and radiological manifestations for both diseases are identical, and there are no pathognomonic symptoms of NTMI. NTM affect the respiratory system and mimic the symptoms of tuberculosis, which significantly complicates not only timely differential diagnosis, but also leads to “treatment failure” of tuberculosis, which the patient did not have. After a month of antimycobacterial treatment an ulcerative lesion of the right vocal fold was diagnosed in the patient. Detection of the culture of NTM 1.5 months after its inoculation was the only one method of diagnosis in this case, the diagnosis NTMI of both the lungs and the larynx was made considering those results. The patient did not receive appropriate treatment before receiving the results of the bacteriological examination, which led to the development of negative clinical and radiological dynamics. But, despite the late diagnosis of NTMI, after 6 months of appropriate treatment the patient had a positive clinical and X-ray dynamics with healing of the ulcerative lesion of the right vocal fold. Thus, the presented case shows that despite the late diagnosis of NTMI of the lungs, which was complicated by NTMI of the larynx during antimycobacterial therapy, in the absence of severe concomitant lung diseases in the patient, after 6 months of appropriate treatment of NTMI, it was possible to achieve positive clinical and radiological dynamics with complete healing of the ulcerative lesion of the right vocal fold.

Management of proliferative thrombovascular necrosis of pinna in a Chippiparai dog

A three-year-old male, Chippiparai dog was presented to the Dermatology unit of Madras Veterinary College Hospital with the complaint of bleeding from right ear tip. History revealed normal appetite, regular deworming and vaccination schedule (recent Anti rabies vaccination). The general clinical examination revealed parameters within the normal range except for the presence of a wedge-shaped ulcerated lesion at the ear tip. Haemogram and serum biochemistry revealed parameters within the normal range. Based on the history of recent vaccination and clinical presentation, the case was diagnosed as proliferative thrombovascular necrosis of the pinna. Treatment was initiated with oral pentoxifylline, doxycycline, niacinamide, vitamin E supplementation and topical tacrolimus application. Uneventful recovery was noticed after one month of treatment.

Assessment of studies on oral manifestations and COVID-19

Aim: This study aimed to evaluate how different study designs influences the presence and characteristics of diagnosis of oral manifestations in patients with COVID-19. Methods: This study is a meta-search conducted with studies evaluating the relationship between patients with oral manifestations and COVID-19. A search was conducted in three databases (PubMed, Web of Science, and Scopus), using terms specific to COVID-19 and oral lesions, including only primary studies. Study selection was undertaken by two reviewers independently. A descriptive analysis was performed. Results: The results included 55 studies in the data synthesis analysis. Most of the studies were case reports and case series. Some of the studies did not relate a biological test to confirm COVID-19. The ulcer lesion and that clinical examination by specialists were the most reported lesion in case reports and case series studies, while taste alterations and patient self-report were more reported in observational studies. Conclusions: This review concluded that the oral lesions in patients with COVID-19 differ according to the study design. The lack of high-quality scientific evidence in the dental literature on COVID-19 makes the findings inconsistent by the lack of sample selection criteria, diagnostic criteria and classification of oral lesions.

An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient: A Proposal for New Diagnostic Criteria.

We report the case of a 28-year-old male with uncontrolled human immunodeficiency virus (HIV) infection who presented with extensive ulcerated lesions with dark lamellated crusting on his face, torso, and limbs. The patient had a rapid plasma reagin (RPR) titer of 1:512, indicative of syphilis. A skin biopsy revealed granulomata surrounded by lymphocytes, histiocytes, and plasma cells, with spirochetes visible on immunohistochemical staining. The patient's rash resolved with hyperpigmented scarring after penicillin and doxycycline treatment. This severe form of secondary syphilis has been termed malignant syphilis, lues maligna, ulceronodular syphilis, or rupioid syphilis. We propose a single descriptive name for this entity, ulceronodular-rupioid syphilis. In 1969, Fisher proposed criteria for malignant syphilis based on lesion appearance, histopathologic findings, high RPR values, and rapid response to treatment. We found that the Fisher criteria were imprecise with respect to specific histopathologic findings, the quantitation of RPR values, and what constitutes rapid response to treatment. Thus, we examined an additional 74 cases from the literature and propose new diagnostic criteria based on rash appearance, histopathologic characteristics, non-treponemal and treponemal test positivity, and response to therapy. We also found that uncontrolled viremia, and not a low CD4 count, is a major risk factor for ulceronodular-rupioid syphilis in HIV patients.

First detection of feline sporotrichosis (Sporothrix brasiliensis) at the zoonoses control service in Campo Grande, Mato Grosso do sul, Brazil.

Sporotrichosis is a traumatic mycosis affecting the skin or subcutaneous tissues caused by Sporothrix dimorphic fungus. The fungal complex includes several pathogenic species, out of which S. brasiliensis and S. schenckii are predominant in Brazil. In Mato Grosso do Sul (MS) state, the first human and animal cases were reported in 2016 in Corumbá and Ladário cities. Accordingly, we present the first occurrences of feline sporotrichosis detected in the state capital Campo Grande, MS, by the Zoonoses Control Service (ZCS) of the Municipal Public Health Department. The study included four allochthonous cases of feline sporotrichosis originating from Corumbá, MS, attended by the ZCS. All four cats presented classical clinical signs of sporotrichosis, as ulcerative nodular cutaneous lesions. Three slides tested positive by direct microscopy and PCR, followed by Sanger sequencing confirmed Sporothrix brasiliensis in two samples. The initial suspicion and diagnosis of feline sporotrichosis at the ZCS highlights the importance of accurate surveillance of sporotrichosis in non-endemic areas to enhance the capacity to prevent, detect and respond to emerging diseases in Campo Grande.

Clinical polymorphism of zoonotic cutaneous leishmaniasis: combination of the clinical and the parasitological diagnosis.

Zoonotic cutaneous leishmaniasis (ZCL) is a neglected tropical disease caused by Leishmania (L.) major. This zoonosis is characterized by a broad-spectrum clinical polymorphism and may be underestimated and poorly treated since it is a simulator of various dermatoses. The aim of our study was to analyze the clinical polymorphism of patients with ZCL. A total of 142 patients with confirmed CL based on the microscopic examination of skin lesion biopsies were included in this study. Molecular typing of Leishmania species revealed that all patients were infected with L. major.In total, 14 clinical formswere observed. Six were typical and eight were atypical. The typical ZCL forms are grouped as follows: papular (26.76%), ulcero-crusted (26.05%), ulcerated (13.38%), impetiginous (9.86%), nodular (9.15%), and papulo-nodular (5.63%) lesions. In atypical ZCL forms, we described erythematous (2.81%), erysipeloid (1.4%), sporotrichoid, (1.4%), keratotic (0.7%) lupoid (0.7%), lichenoid (0.7%), psoriasiform (0.7%), and zosteriform (0.7%) lesions. Here, the lichenoid and the keratotic forms caused by L. major were reported for the first time in Tunisia. These findings will help physicians to be aware of the unusual lesions of ZCL that could be confused with other dermatological diseases. For this reason, it will be necessary to improve the diagnosis of CL especially in endemic areas. Such large clinical polymorphism caused by L. major may be the result of a complex association between the vector microbiota, the parasite, and the host immune state, and further studies should be carried out in order to reveal the mechanisms involved in clinical polymorphism of ZCL.

Phase I study of copaiba aqueous mouthwash in patients with head and neck cancer undergoing radiotherapy.

e24103 Background: Due to the contraindication of low-power laser therapy in the tumor region, the use of copaiba for the management of oral mucositis was proposed, given its anti-inflammatory, antimicrobial and healing properties. This study aimed to evaluate the dose-limiting toxicity/maximum tolerated dose of copaiba aqueous mouthwash solution. Methods: This is a phase I study including patients with cavity or oropharynx cancer (CID-10 C00-C06,10), undergoing radiotherapy alone or associated with chemotherapy. Six successive cohorts were proposed, with a minimum of 3 patients each. The copaiba aqueous mouthwash was used daily starting on the first day of radiotherapy and up to 37 days, associated with Low Power Laser applications (100Mw, 660nm, beam area 0.09842 cm²,1J) in non-tumoral areas. In cohorts 1, 2, and 3, a 10% solution was used, and in cohorts 4, 5, and 6, 15%, 2, 3 and 4 times a day, respectively. Daily assessment was carried out evaluating the presence of oral mucositis lesions (World Health Organization and Oral Mucositis Assessment Scale) and complaints of pain (CTCAE v5.0 and Visual Analogue Pain Scale) and xerostomia (presence or absence). Sialometry was carried out through the collection of unstimulated saliva (by Davies (2002) criteria), once a week. Results: Twenty patients were included (cohort 1 = 5, cohort 2 = 3, cohort 3 = 3, cohort 4 = 3, cohort 5 = 3, cohort 6 = 3) - 1 patient was excluded and 1 discontinued from cohort 1 (due to changes in radiotherapy planning and non-adherence to dentistry appointments). A total of 19 participants used the mouthwash. Most of the participants were women (57.9%), with a median age of 63.2 years, and performance status 1 (84.2%). Most tumors were squamous cell carcinomas (84.2%), 47.4% of them in the palate; 57.9% were staged as IVA. Themedian total radiotherapy dose was 68.0 (60.0-70.0) Gy delivered in 33.0 (30.0-34.5) fractions. Pain in the oral cavity (73.7%) and oropharynx (52.6%) were referred, graded respectively as 4.5 (0.75-7) and 1.5 (0-6). Oral mucositis was classified as grade 3 at most; none of the patients developed grade 4 or had to have radiotherapy interrupted due to toxicity. Ulcerated lesions of oral mucositis developed in the tumor area in 68.4% of patients and non-tumor areas in 84.2%. Patients complained of xerostomia in 73.7% of cases and the median unstimulated sialometry was 0.17mL/min. None of the patients experienced dose-limiting toxicity related to the copaiba solution. Conclusions: Copaiba mouthwash did not trigger dose-limiting toxicity in any of the patients throughout the study, leading to amaximum tolerated dose of 15%, 4 times/day. None of the patients complained of pain or burning related to the use of mouthwash in the absence of oral mucositis lesions, suggesting that it is safe and non-toxic for this use. In this sense, considering the obtained results, the development of a phase II study becomes the next logical step in this research area. Clinical trial information: ID - 34635020.5.0000.5274.

Comparative analysis of computer vision algorithms for the real-time detection of digital dermatitis in dairy cows

Digital dermatitis (DD) is a bovine claw disease responsible for ulcerative lesions on the planar aspect of the hoof. DD is associated with massive herd outbreaks of lameness and influences cattle welfare and production. Early detection of DD can lead to prompt treatment and decrease lameness. Computer vision (CV) provides a unique opportunity to improve early detection. The study aims to train and compare applications for the real-time detection of DD in dairy cows. Eight CV models were trained for detection and scoring, compared using performance metrics and inference time, and the best model was automated for real-time detection using images and video. Images were collected from commercial dairy farms while facing the interdigital space on the plantar surface of the foot. Images were scored for M-stages of DD by a trained investigator using the M-stage DD classification system with distinct labels for hyperkeratosis (H) and proliferations (P). Two sets of images were compiled: the first dataset (Dataset 1) containing 1,177 M0/M4H and 1,050 M2/M2P images and the second dataset (Dataset 2) containing 240 M0, 17 M2, 51 M2P, 114 M4H, and 108 M4P images. Models were trained to detect and score DD lesions and compared for precision, recall, and mean average precision (mAP) in addition to inference time in frame per second (FPS). Seven of the nine CV models performed well compared to the ground truth of labeled images using Dataset 1. The six models, Faster R-CNN, Cascade R-CNN, YOLOv3, Tiny YOLOv3, YOLOv4, Tiny YOLOv4, and YOLOv5s achieved an mAP between 0.964 and 0.998, whereas the other two models, SSD and SSD Lite, yielded an mAP of 0.371 and 0.387 respectively. Overall, YOLOv4, Tiny YOLOv4, and YOLOv5s outperformed all other models with almost perfect precision, perfect recall, and a higher mAP. Tiny YOLOv4 outperformed all other models with respect to inference time at 333 FPS, followed by YOLOv5s at 133 FPS and YOLOv4 at 65 FPS. YOLOv4 and Tiny YOLOv4 performed better than YOLOv5s compared to the ground truth using Dataset 2. YOLOv4 and Tiny YOLOv4 yielded a similar mAP of 0.896 and 0.895, respectively. However, Tiny YOLOv4 achieved both higher precision and recall compared to YOLOv4. Finally, Tiny YOLOv4 was able to detect DD lesions on a commercial dairy farm with high performance and speed. The proposed CV tool can be used for early detection and prompt treatment of DD in dairy cows. This result is a step towards applying CV algorithms to veterinary medicine and implementing real-time DD detection on dairy farms.

Monoclonal gammopathy in the setting of Pyoderma gangrenosum.

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by ulcerative painful lesions with violaceous undermined borders. Up to 75% of PG cases develop in association with an underlying systemic disease. Monoclonal gammopathy is reportedly a concomitant condition with PG, with studies indicating immunoglobulin (Ig) A gammopathy as the most common. Whether gammopathy is associated with PG or is an incidental finding has been debated. We sought to investigate the association and characteristics of gammopathy in patients with PG. We retrospectively identified PG patients at our institution from 2010 to 2022 who were screened for plasma cell dyscrasia. Of 106 patients identified, 29 (27%) had a gammopathy; subtypes included IgA (41%), IgG (28%), and biclonal (IgA and IgG) (14%). Mean age was similar between those with and without gammopathy (60.7 vs. 55.9 years; P = .26). In addition, hematologic or solid organ cancer developed in significantly more patients with vs. without gammopathy (8/29 [28%] vs. 5/77 [6%]; P = .003). Among the subtypes of gammopathy, IgG monoclonal gammopathy had the highest proportion of patients with subsequent cancer development (4 of 8 patients, 50%). Study limitations include a retrospective, single-institution design with a limited number of patients. Overall, our data show a high prevalence of gammopathy in patients with PG; those patients additionally had an increased incidence of cancer, especially hematologic cancer.