scholarly journals Pyoderma Gangrenosum: A Rare Cause of Cutaneous Ulceration and One Easily Misdiagnosed

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Wedad Abdelrahman ◽  
Maureen Y. Walsh ◽  
Susannah E. Hoey ◽  
Donal O’Kane
Keyword(s):  
Skin Biopsy ◽  
Pyoderma Gangrenosum ◽  
Clobetasol Propionate ◽  
Neutrophilic Dermatosis ◽  
Dramatic Improvement ◽  
Left Shift ◽  
Neutrophilic Infiltrate ◽  
Deep Ulceration ◽  
One Year ◽  
In Infants And Children

Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis often misdiagnosed. It is uncommon in infants and children accounting for 4% of cases. A one-year-old male in paediatric ICU ventilated for bronchopneumonia was referred with ulcerated areas on his neck and axilla corresponding to sites of recent removal of central and arterial lines. Examination revealed areas of deep ulceration with violaceous undermined borders in keeping with PG. This was supported by a skin biopsy showing a neutrophilic infiltrate in the deeper dermis. Topical clobetasol propionate was commenced and a dramatic improvement within 24 hours noted. Blood results showed a leucocytosis of 29.7; a differential WCC showed toxic granulation in neutrophils with myeloid left shift; immunoglobulins showed elevated IgG 23 and IgA 4.86. The elevated WCC made us consider a leukaemic trigger; however, they settled with treatment of the underlying infection. PG in children is more likely to have an atypical distribution involving the head and neck (26.6%) or buttocks (15%). An interesting feature in this case is the presence of pathergy, a term used to describe the induction or exacerbation of PG at sites of iatrogenic or incidental trauma. It is seen in 31% of patients with PG.

scholarly journals Pyoderma gangrenosum with renal and splenic impairment - case report

2013 ◽  
Vol 88 (6 suppl 1) ◽  
pp. 150-153 ◽  
Author(s):  
Luciana Rabelo de Carvalho ◽  
Virgínia Vinha Zanuncio ◽  
Bernardo Gontijo
Keyword(s):  
Case Report ◽  
Renal Impairment ◽  
Pyoderma Gangrenosum ◽  
Lower Limbs ◽  
Neutrophilic Dermatosis ◽  
Internal Organs ◽  
Cutaneous Manifestations ◽  
Neutrophilic Infiltrate ◽  
Multisystemic Disease

Pyoderma gangrenosum is an uncommon and recurrent neutrophilic dermatosis of unknown cause. The lesions usually start as tender sterile papulopustules or erythematous nodules that undergo necrosis followed by ulceration. The lower limbs are most commonly affected and around half of the cases are associated with systemic disorders. Although rare, cases of pyoderma gangrenosum with extramucocutaneous sterile neutrophilic infiltrate have been reported, with the lungs being the most commonly affected organ. We report a case of pyoderma gangrenosum with splenic and renal impairment. Pyoderma gangrenosum should be considered a multisystemic disease with classic cutaneous manifestations and potential involvement of internal organs.

scholarly journals Post-surgical pyoderma gangrenosum following electrosurgery and elliptical excision: A rare disease following common procedures

2021 ◽  
Vol 12 (1) ◽  
pp. 54-57
Author(s):  
Mario Gaston Toledo Lelevier ◽  
Raul Gerardo Mendez Flores ◽  
Luzma Kareena Jimenez Leon ◽  
Teresa Aranzazu Gomez Cevallos ◽  
Marisol Ramirez Padilla
Keyword(s):  
Early Diagnosis ◽  
Skin Biopsy ◽  
Rare Disease ◽  
Immunosuppressive Therapy ◽  
Surgical Resection ◽  
Pyoderma Gangrenosum ◽  
Postoperative Period ◽  
Neutrophilic Dermatosis ◽  
Excellent Outcome ◽  
High Index Of Suspicion

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis with an estimated annual incidence of 3–10 cases per million per year. Post-surgical pyoderma gangrenosum (PSPG) refers to the development of pyoderma gangrenosum at surgical sites in the postoperative period. A 55-year-old female was admitted with two acute and enlarging painful breast ulcerations resistant to antibiotic treatment following surgical resection and electrofulguration by her dermatologist. Multiple wound cultures were negative. A skin biopsy was consistent with PG and the wounds improved after adequate oral immunosuppressive therapy. A high index of suspicion, exclusion of other differential diagnoses, and previous experience with this disease ensured an early diagnosis, prevented injury to life and unnecessary debridement, and resulted in an excellent outcome for the patient.

scholarly journals Citrullinemia Type I - A Case Report

2016 ◽  
Vol 33 (2) ◽  
pp. 98-100
Author(s):  
Fauzia Mohsin ◽  
Sharmin Mahbuba ◽  
Tahmina Begum ◽  
Narayan Chandra Saha ◽  
Kishwar Azad ◽  
...  
Keyword(s):  
Urea Cycle ◽  
Female Child ◽  
Amino Acid Profile ◽  
Dramatic Improvement ◽  
Type I ◽  
Frequent Vomiting ◽  
Cycle Disorders ◽  
One Year ◽  
High Level ◽  
Citrullinemia Type I

Citrullinemia type I (CTLN1) is an inherited urea cycle disorder where the enzyme argininosuccinate synthetase is deficient. It can lead to recurrent hyperammonemic crisis that may result in permanent neurological sequelae, even death. Vomiting in patients with urea cycle disorders may either be the result or cause of acute hyperammonemia, particularly if due to an illness that leads to catabolism. Therefore, age-appropriate common etiologies of vomiting must be considered when evaluating these patients. We present a case of a 2 year 5 month old female child with CTLN1 who had a history of frequent vomiting after the age of one year and some recent neurological manifestations like excessive crying and lethargy and one episode of unconsciousness. Investigations revealed high level of ammonia. Amino acid profile using tandem mass spectrometry showed markedly increased plasma level of citrulline. After administration of sodium benzoate and protein restricted diet there was dramatic improvement of all the symptoms.J Bangladesh Coll Phys Surg 2015; 33(2): 98-100

scholarly journals A Rare Case of Pyoderma Gangrenosum in a HIV Positive Patient

2011 ◽  
Vol 2 (2) ◽  
pp. 128-130
Author(s):  
Eswari Loganathan ◽  
Asima Banu
Keyword(s):  
Pyoderma Gangrenosum ◽  
Rare Case ◽  
Positive Patient ◽  
Neutrophilic Dermatosis ◽  
Hiv Positive ◽  
Medical Sciences ◽  
First Line ◽  
Hodgkins Lymphoma ◽  
Lymphoid Malignancies ◽  
Non Hodgkins Lymphoma

HIV infection can lead to varied spectrum of associated disease conditions. Pyoderma gangrenosum is a neutrophilic dermatosis that may be associated with myeloid malignancies. Less information is available about the association of pyoderma gangrenosum with lymphoid malignancies. We report a rare case of pyoderma gangrenosum in association with Non hodgkins lymphoma(NHL) of diffuse large B cell type. In this case the lesion which showed NHL features occurred in the perianal region, coexisting with pyoderma gangrenosum lesions in the perianal, lower limb and abdominal region. Another interesting feature is the occurrence of both these conditions in a HIV-positive patient with severe immunologic failure to first line antiretroviral therapy contributing to the refractoriness to treatment. Key Words: HIV; pyoderma gangrenosum; Non Hodgkins Lymphoma DOI: http://dx.doi.org/10.3126/ajms.v2i2.4029 Asian Journal of Medical Sciences 2 (2011) 128-130

The Importance of Early Diagnosis of Pyoderma Gangrenosum: A Case After Plastic Surgery

2021 ◽  
Vol 33 (7) ◽  
pp. E58-E60
Author(s):  
Gunel Guliyeva ◽  
Ali Kilic
Keyword(s):  
Hospital Stay ◽  
Plastic Surgery ◽  
Pyoderma Gangrenosum ◽  
Reduction Mammoplasty ◽  
Careful Examination ◽  
Neutrophilic Dermatosis ◽  
Unknown Etiology ◽  
Surgical Trauma ◽  
Surgical Interventions ◽  
Low Incidence

Introduction. Pyoderma gangrenosum (PG) is a multifactorial neutrophilic dermatosis of unknown etiology. It can occur in isolation; in association with different inflammatory, autoimmune, or malignant diseases; or as part of various syndromes. Because of its low incidence and the difficulty in distinguishing it from other possible lesions, PG is usually misdiagnosed. As a result, patients may be subjected to unnecessary treatments and surgical interventions that exacerbate the development of PG, as pathergy phenomenon is observed with this skin disorder. Surgical trauma can also lead to the formation of PG with the same mechanism. The occurrence of PG lesions has been reported after plastic surgery as well. In most cases, however, the diagnosis is delayed, resulting in disfigurement, additional surgeries, and extended hospital stay. Case Report. In this article, a case of early detected bilateral PG after reduction mammoplasty in a patient with no personal or family history of autoimmune disorders is presented. Careful examination of the wound and analysis of the clinical picture resulted in the diagnosis of PG. Conclusions. The authors believe that the description of the diagnostic clues considered in this case will aid the plastic surgeon in prompt recognition and management of postoperative PG, with the aim of decreasing patient morbidity and the duration of hospital stay while preventing additional complications.

CASE FATALITY IN INFANTS AND CHILDREN WITH PERTUSSIS, 1942-1946

PEDIATRICS ◽  
1950 ◽  
Vol 5 (5) ◽  
pp. 840-852
Author(s):  
JEROME L. KOHN ◽  
ALFRED E. FISCHER ◽  
HERBERT H. MARKS
Keyword(s):  
United States ◽  
Case Fatality Rate ◽  
Communicable Disease ◽  
Case Fatality ◽  
The United States ◽  
Fatality Rate ◽  
Older Children ◽  
Severity Of The Disease ◽  
One Year ◽  
In Infants And Children

Analysis of data on patients with pertussis during 1942-1946 obtained by means of a questionnaire from communicable disease hospitals and from health officers in a number of cities in the United States and Canada showed these results: Case fatality rates of patients admitted to hospitals for treatment have declined substantially in the period under review. This decline is general, both among infants under one year of age and among older children. In 1946, the case fatality rate of the infants hospitalized for the disease was 5.0% in those cities for which data for at least four years were available. This may be compared with the rate of 7.8% in 1942 and 11.1% in 1943. At ages one year and over, the rate was only 1.3% in 1946, as compared with 1.7% in 1942 and 3.7% in 1943. The rates in the hospitals with larger experiences were generally more favorable than in hospitals with smaller experiences. Despite the incomplete reporting of pertussis, which results in exaggerating the case fatality rate for the general population, the level of these rates in the community as a whole was lower than for hospitalized cases. This reflects the higher proportion of the severer cases in the hospitalized group. Indications are that in many places hospitalization is limited more and more to severe cases. Progress in the management of pertussis, especially of the severer cases admitted to hospitals, is believed to be the chief factor in the decline in case fatality of pertussis. A request contained in the questionnaire for an opinion on the severity of pertussis during the period studied elicited few replies, and these replies showed a division of opinion on the matter. It appears unlikely that there has been much of any change in the severity of the disease.

Pyoderma Gangrenosum Mimicking Antiphospholipid Antibody Syndrome in a Child With Juvenile Systemic Lupus Erythematosus

2020 ◽  
Author(s):  
metin kaya gürgöze ◽  
Aslıhan Kara ◽  
Mehmet yusuf sarı ◽  
İlknur Çalık ◽  
Saadet Akarsu
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Skin Biopsy ◽  
Pyoderma Gangrenosum ◽  
Lupus Erythematosus ◽  
Anticoagulation Therapy ◽  
Anticardiolipin Antibody ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Systemic Lupus ◽  
History Of

Abstract Background: Although pyoderma gangrenosum (PG) -like lesions have been rarely described in adults with the antiphospholipid antibody syndrome (APS) and systemic lupus erythematosus (SLE), the occurrence of PG as a preceding manifestation of APS in children with SLE has not been reported until. We present a young girl with SLE and APS who developed progressive extstensive ulcerations that were consistent with PG.Case presentation: A 14-year-old girl with a 2-year history of SLE was admitted to our department, complaining painful crusted ulcerations on her legs. Skin biopsy was reported as PG. However, she did not respond to immunosuppressive therapy administered. When her skin biopsy findings is reassessed in keeping with the positive anticardiolipin antibody results, superficial small vessel microthrombosis was observed. Diagnosis of APS and PG developing secondary to SLE were made. It was resulted in marked clinical improvement with anticoagulation therapy in addition to immunosuppressives as is recommended in APS. Conclusions: Based in clinical, pathological and response to proposed treatment, we can state that PG -like lesions in children with SLE could be considered as a secondary form of APS.

scholarly journals A man with recurrent fever, arthritis, and rashes-brucellosis? A case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wen Wang ◽  
Xu Lu ◽  
Chengbo Li ◽  
Myong Jun Ri ◽  
Wei Cui
Keyword(s):  
Infectious Disease ◽  
Bone Marrow ◽  
Case Report ◽  
Myelodysplastic Syndrome ◽  
Skin Biopsy ◽  
Rare Case ◽  
Glucocorticoid Therapy ◽  
Recurrent Fever ◽  
Neutrophilic Dermatosis ◽  
Case Presentation

Abstract Background We report a rare case of chronic brucellosis accompanied with myelodysplastic syndrome and neutrophilic dermatosis, which to the best of our knowledge, has never been reported. Case presentation A young man was admitted to our hospital complaining of recurrent fever, arthritis, rashes and anemia. He had been diagnosed with brucellosis 6 years prior and treated with multiple courses of antibiotics. He was diagnosed with myelodysplastic syndrome and neutrophilic dermatosis following bone marrow puncture and skin biopsy. After anti-brucellosis treatment and glucocorticoid therapy, the symptoms improved. Conclusions Clinicians should consider noninfectious diseases when a patient who has been diagnosed with an infectious disease exhibits changing symptoms.

scholarly journals Utility of uroflowmetry during the follow-up of children affected by balanitis xerotica obliterans (BXO)

2018 ◽  
Vol 90 (2) ◽  
pp. 123 ◽  
Author(s):  
Salvatore Arena ◽  
Tiziana Russo ◽  
Pietro Impellizzeri ◽  
Saveria Parisi ◽  
Patrizia Perrone ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Voiding Dysfunction ◽  
Clobetasol Propionate ◽  
Histological Diagnosis ◽  
Balanitis Xerotica Obliterans ◽  
Urethral Stenosis ◽  
Urethral Dilatation ◽  
One Year

Introduction: To evaluate the outcome of circumcised patients with balanitis xerotica obliterans (BXO) using uroflowmetry (UF). Methods: Between 2011 and 2013, 180 children underwent a circumcision for phimosis. The foreskin was examined on microscopy. Patients with an histological diagnosis of BXO were included in the study. Patients with BXO underwent UF two weeks after surgery and treatment with clobetasol propionate ointment. Patients were re-evaluated at 6, 12, 18 and 24 months postoperatively clinically and using UF. Results: 75 of 180 circumcised patients (41.6%) were included. At two weeks, Thirtytwo of 75 patients (42.7%) displayed a pathological UF. At six months, 15 patients (20%) had pathological UF and a new cycle of clobetasol was prescribed. At one year, 10 patients (13.3%) displayed patholgocial UF and underwent progressive urethral dilatation or meatoplasty. At 18 months, 71 patients (94.7%) displayed regular UF, 3 underwent a meatoplasty and one a staged urethroplasty for a severe urethral stenosis. At two years, UF was normal in 74 out of 75 (98.7%). Conclusions: We recommend to send for hystological examination all foreskins excised after circumcision. We believe that a clinical and uroflowmetric follow-up of pediatric patients with BXO is mandatory for a prompt identification of post-voiding dysfunction.

Applying Intravenous Immunoglobulin and Negative-Pressure Wound Therapy to Treat Refractory Pyoderma Gangrenosum: A Case Report

2020 ◽  
pp. 153473462094045
Author(s):  
Shi-Ying Jin ◽  
Mei Chen ◽  
Feng-Yuan Wang ◽  
Fei Wang
Keyword(s):  
Intravenous Immunoglobulin ◽  
Pyoderma Gangrenosum ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Lower Leg ◽  
Neutrophilic Dermatosis ◽  
Wound Therapy ◽  
Systemic Corticosteroids ◽  
Painful Ulcer ◽  
The Right

Pyoderma gangrenosum (PG) is a rare chronic neutrophilic dermatosis that causes undermining ulcers. Unfortunately, standardization of PG treatment remains a challenge. In this article, we describe a case in which a 69-year-old man presented with a painful ulcer on the right lower leg. The diagnosis of PG was made after excluding other diseases. He had a history of PG on his left lower leg 2 years earlier and was cured by the treatment of systemic corticosteroids and cyclosporin A for 43 days. However, such a treatment was not effective this time. Hence, we applied intravenous immunoglobulin and negative-pressure wound therapy, and the patient was cured. Altogether, this case supports the use of intravenous immunoglobulin as an effective adjuvant for refractory PG, and indicates negative-pressure wound therapy as a treatment option to advance ulcer healing under adequate immunosuppression.

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