Pyoderma Gangrenosum Induced by BNT162b2 COVID-19 Vaccine in a Healthy Adult

(1) Background: Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis of unknown etiology. Coronavirus disease 2019 (COVID-19) vaccines can cause a variety of adverse cutaneous manifestations. PG associated with mRNA vaccines has not previously been described. This case study reports on the first patient to develop PG after receiving BNT162b2. (2) Case Presentation: An otherwise-healthy 27-year-old man developed multiple skin lesions 24 h after receiving the first dose of the messenger RNA-based Pfizer/BioNTech BNT162b2 COVID-19 vaccine. When in hospital, he developed a new painful ulcerative lesion on his right hand. Skin ulcer edge biopsy showed severe epidermal neutrophilic infiltrate with epidermal and dermal edema, underlying superficial dermal necrosis, and characteristic undermining with extensive mixed inflammatory infiltration of the dermis and abscess formation consistent with an ulcer with mixed dermal inflammation compatible with pyoderma gangrenosum. The lesion showed rapid improvement after the initiation of immunosuppressive therapy. (3) Conclusions: PG may be a rare adverse event related to the BNT162b2 vaccine, which could be more frequently encountered with the wide-scale use of mRNA vaccines. The continuous monitoring and surveillance of skin manifestations post-vaccination is essential.

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Pyoderma gangrenosum – an interdisciplinary approach to the disease

HIGHER SCHOOL’S PULSE ◽

10.5604/01.3001.0012.7978 ◽

2018 ◽

Vol 12 (4) ◽

pp. 61-64

Author(s):

Aleksandra Kapuśniak ◽

Aleksandra Czachor ◽

Grażyna Wąsik

Keyword(s):

Pyoderma Gangrenosum ◽

Rapid Development ◽

Calcineurin Inhibitors ◽

Skin Lesions ◽

Neutrophilic Dermatosis ◽

Unknown Etiology ◽

Neutrophilic Infiltration ◽

Inflammatory Infiltration ◽

Laboratory Findings ◽

Immunological Mechanisms

Pyoderma gangrenosum is a rare dermatosis of unknown etiology. It is classified as being a neutrophilic dermatosis, in which there is inflammatory infiltration consisting primarily of mature polynuclear leukocytes. Its pathogenesis is multifactorial and is thought to involve neutrophilic dysfunction, inflammatory mediators in combination with a genetic predisposition for the disease. Neutrophilic infiltration is observed in new lesions, while necrosis associated with fibrosis and granulomas are seen in chronic lesions, however these findings are not pathognomonic. Pyoderma gangrenosum can occur at any age. However, it most commonly develops in young and middle-aged adults predominantly women between the second and fifth decades of life. Grossly, pyoderma gangrenosum is characterized by skin lesions in the form of rapidly spreading ulcers, with cylindrical edges and necrotic bottoms. These ulcers are painful and crusted but have undermined borders. Pyoderma gangrenosum commonly presents with the rapid development of one or more purulent ulcers with undermined borders on sites of normal or traumatized skin. Pyoderma gangrenosum is often associated with other systemic diseases such as ulcerative colitis, Crohn’s disease, monoclonal gammopathies, IgG or IgA myelomas and tumors of internal organs and hematopoietic system diseases, which supports the immunological mechanisms involved in the pathogenesis of the disease. Of note, neutrophilic infiltration associated with other extracutaneous manifestations and different systemic disorders can co-exist with pyoderma gangrenosum. Despite the recent development of immune modulating drugs in the treatment of skin conditions, steroid therapy still plays a pivotal role. For patients with mild pyoderma gangrenosum, the local application of topical corticosteroids or calcineurin inhibitors can be sufficient. Systemic therapy is necessary in patients with more extensive disease. The role of surgery is controversial, as it is associated with the induction of pathergy. The clinical, histopathologic and laboratory findings in pyoderma gangrenosum are non-specific, and a diagnosis can only be made once other diagnoses have been excluded.

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

WOUNDS A Compendium of Clinical Research and Practice ◽

10.25270/wnds/2021.e5860 ◽

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.

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Takayasu arteritis with pyoderma gangrenosum: case reports and literature review

BMC Rheumatology ◽

10.1186/s41927-019-0098-z ◽

2019 ◽

Vol 3 (1) ◽

Cited By ~ 1

Author(s):

Xuehan Zhang ◽

Yang Jiao

Keyword(s):

Pyoderma Gangrenosum ◽

Takayasu Arteritis ◽

Case Reports ◽

Disease Process ◽

Skin Lesions ◽

Clinical Severity ◽

Chinese Patients ◽

Neutrophilic Dermatosis ◽

American College Of Rheumatology ◽

Pubmed Database

Abstract Background Takayasu arteritis is a rare, chronic inflammatory arteriopathy affecting mainly the aorta and its branches. Many skin manifestations have been reported in association with this disease. Pyoderma gangrenosum is a skin complication that is a neutrophilic dermatosis characterized by destructive, necrotizing and noninfective skin infiltration. However, there are no related records on these conditions in Chinese patients. Case presentation We reported two Chinese female patients presenting with pyoderma gangrenosum associated with Takayasu arteritis. Pyoderma gangrenosum preceded Takayasu arteritis in both patients. Their skin lesions were diagnosed as pyoderma gangrenosum through skin biopsy and relieved after treating with steroids and immunosuppressants. During the follow-up, both patients developed symptoms caused by vascular stenosis and occlusion, such as dizziness and weakness of upper limb. The results of aortic angiography revealed multiple large arteries narrowed and blocked. According to the criteria of the American College of Rheumatology, the vasculitis in both patients were classified as Takayasu arteritis. Since there was scant evidence of active inflammation and the skin lesions were stable, neither of them was given strong immnosuppressive therapy. The PubMed database was also searched and 16 related well-documented cases of Takayasu with pyoderma gangrenosum were reviewed and summarized. Conclusions Pyoderma gangrenosum could occur at any stage of the Takayasu arteritis disease process. No correlation was found between the location of the skin lesions and the clinical severity and scope of Takayasu arteritis. It is important to remember the rare possibility of Takayasu arteritis in patients with skin lesions indicative of pyoderma gangrenosum of unknown aetiology. Obtaining the relevant history and regular monitoring of the arteries are necessary.

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Pyoderma gangrenosum with renal and splenic impairment - case report

Anais Brasileiros de Dermatologia ◽

10.1590/abd1806-4841.20132448 ◽

2013 ◽

Vol 88 (6 suppl 1) ◽

pp. 150-153 ◽

Cited By ~ 7

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.

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Bortezomid-Induced Sweet Syndrome.

Blood ◽

10.1182/blood.v108.11.5128.5128 ◽

2006 ◽

Vol 108 (11) ◽

pp. 5128-5128

Author(s):

Aline A. Schmidt-Tanguy ◽

Martine M. Avenel-Audran ◽

Séverine S. Lissandre ◽

Mammoun M. Dib ◽

Anne A. Croue ◽

...

Keyword(s):

Histopathological Examination ◽

Skin Lesions ◽

Pulmonary Complications ◽

Neutrophilic Dermatosis ◽

High Dose ◽

Cutaneous Lesions ◽

Cutaneous Manifestations ◽

Sweet Syndrome ◽

The Third ◽

Periorbital Oedema

Abstract Bortezomid (VELCADE®) is a potent proteasome inhibitor used in patients with relapsed and/or refractory multiple myeloma (MM). Numerous undesirable effects are known including thrombocytopenia, neuropathy, various gastrointestinal disorders, fatigue, or rare pulmonary complications. Cutaneous complications have also been described. We reported here a case of Bortezomid-induced Sweet syndrome. A 72-year-old man received Bortezomid for a second relapse of MM previously treated with VAD (vincristine, adriamycin, dexamethasone), double high dose melphalan and autologous transplant, and thalidomide. Bortezomid was given at the dose of 1.3 mg/m2 on days 1, 4, 8, and 11 every 21 days. Dexamethasone was associated with the first cycle at the dose of 20mg/d given on days 1, 2, 4, 5, 8, and 9. On day 11 of the third cycle, a partial response was observed. However, the patient presented a painful skin eruption without any fever. Centimetric erythematous, oedematous papulo-nodular plaques were observed on his back and a periorbital oedema. Spontaneous partial regression was noted on the first day of the following cycle but major analgesic drug were necessary. These cutaneous lesions on the back and the dorsal of fingers recurred on the fourth and fifth cycles with a maximum on day 11. Histopathological examination of a lesion showed oedeme of the dermis and a perivascular polymorphic dermal infiltrate of lymphocytes, neutrophils and eosinophils with some leukocytoclasia, but without parietal necrosis or vasculitis. This findings were consistent with neutrophilic dermatosis. During the sixth Bortezomid cycle, the administration of dexamethasone 20 mg/d on days 1, 2, 4, 5, 8, 9, 11, and 12 prevents the reoccurrence of the skin lesions but the periorbital oedema persists. A variety of cutaneous manifestations has been described in MM. Sweet syndrome has been described in two untreated MM or in some patients receiving granulocyte-colony stimulating factor. Bortezomid has been associated with rash, pruritus, erythema, periorbital oedema, urticaria, alopecia, skin nodules. Few cases of non-necrotising cutaneous vasculitis with perivascular lymphocytic infiltrates have also been reported. Bortezomid-induced Sweet syndrome has been reported in three other patients at the second and third injection of the second cycle for two of them while the eruption occurred after the first injection in the third case. The recurring skin lesions after each bortezomid cycle strongly suggests Bortezomid responsibility’s in the occurrence of Sweet syndrome. Unlike classic hypersensitivity type reactions, this vasculitis rash may not necessary prompt cessation of drug as the administration of dexamethasone prevents its recurrence.

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Cutaneous Manifestations of Systemic Lupus Erythematosus

Autoimmune Diseases ◽

10.1155/2012/834291 ◽

2012 ◽

Vol 2012 ◽

pp. 1-15 ◽

Cited By ~ 13

Author(s):

Luís Uva ◽

Diana Miguel ◽

Catarina Pinheiro ◽

João Pedro Freitas ◽

Manuel Marques Gomes ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Clinical Manifestations ◽

Skin Lesions ◽

Unknown Etiology ◽

Systemic Lupus ◽

Cutaneous Lesions ◽

Optimal Care ◽

Cutaneous Manifestations ◽

American College Of Rheumatology

Systemic lupus erythematosus (SLE) is a multiorgan autoimmune disease of unknown etiology with many clinical manifestations. The skin is one of the target organs most variably affected by the disease. The American College of Rheumatology (ACR) established 11 criteria as a classificatory instrument to operationalise the definition of SLE in clinical trials. They were not intended to be used to diagnose individuals and do not do well in that capacity. Cutaneous lesions account for four of these 11 revised criteria of SLE. Skin lesions in patients with lupus may be specific or nonspecific. This paper covers the SLE-specific cutaneous changes: malar rash, discoid rash, photosensitivity, and oral mucosal lesions as well as SLE nonspecific skin manifestations, their pathophysiology, and management. A deeper thorough understanding of the cutaneous manifestations of SLE is essential for diagnosis, prognosis, and efficient management. Thus, dermatologists should cooperate with other specialties to provide optimal care of SLE patient.

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Cutaneous manifestations of COVID-19 in Mexican patients: A case series and review of literature

SAGE Open Medical Case Reports ◽

10.1177/2050313x21997194 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2199719

Author(s):

Juan Carlos Palomo-Pérez ◽

Maria Elisa Vega-Memije ◽

David Aguilar-Blancas ◽

Erik González-Martínez ◽

Lucia Rangel-Gamboa

Keyword(s):

Respiratory Symptoms ◽

Case Series ◽

Signs And Symptoms ◽

Skin Lesions ◽

World Health ◽

Medical Community ◽

Atypical Pneumonia ◽

Cutaneous Lesions ◽

Cutaneous Manifestations ◽

Mexican Patients

China officially recognized atypical pneumonia outbreak in December 2019; on 11 March 2020, the World Health Organization declared COVID-19 as a pandemic that is produced by a new coronavirus, named SARS-CoV-2, of rapid transmissibility, which can be asymptomatic, with mild to severe respiratory symptoms, and with cardiovascular, neurological, gastrointestinal, and cutaneous complications. Considering that the pandemic prolonged more than initially expected was prognostic, it is essential for the medical community to identify the signs and symptoms of COVID-19. Thus, this work’s objectives were to present cases of cutaneous lesions observed in COVID-19 Mexican patients. We register cutaneous lesions in COVID-19 patients referred from internal medicine and otorhinolaryngology services to dermatology. We presented four interesting cases with cutaneous lesions, including exanthema morbilliform, urticaria, chilblains, ecchymosis, and facial edema, and review the available literature. The most frequent cutaneous markers are rash, chilblains, and urticaria. Skin lesions may be the first manifestation of COVID-19, accompany initial respiratory symptoms, or appear during the disease course. Symptoms associated with vascular changes (livedo reticularis and vasculitis) are considered of poor prognosis.

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Pyoderma Gangrenosum and Erythema Nodosum Revealing Takayasu’s Arteritis

Case Reports in Dermatology ◽

10.1159/000452829 ◽

2016 ◽

Vol 8 (3) ◽

pp. 354-357 ◽

Cited By ~ 8

Author(s):

Jonas Loetscher ◽

Susanna Fistarol ◽

Ulrich A. Walker

Keyword(s):

Pyoderma Gangrenosum ◽

Erythema Nodosum ◽

Takayasu’S Arteritis ◽

Skin Lesions ◽

Takayasu's Arteritis ◽

Young Females ◽

Worldwide Distribution ◽

Asian Populations ◽

Asian Patients ◽

Caucasian Female

We report a Caucasian female who presented with simultaneous erythema nodosum and pyoderma gangrenosum due to underlying Takayasu’s arteritis. Takayasu’s arteritis is a chronic large vessel vasculitis of unknown cause. The disease has a worldwide distribution but is most commonly seen in Asian populations. There is a strong predilection for young females. The clinical presentation is variable, but mostly derives from stenosis or occlusion of affected arteries, resulting in claudication and ischemia. Skin manifestations are observed in up to 28% of patients with Takayasu’s arteritis, with erythema nodosum reported more frequently in Caucasians. Pyoderma gangrenosum is more common in Asian patients. This report demonstrates the importance to exclude Takayasu’s arteritis in patients with such skin lesions.

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A Rare Case of Pyoderma Gangrenosum in a HIV Positive Patient

Asian Journal of Medical Sciences ◽

10.3126/ajms.v2i2.4029 ◽

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

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Dermoscopy and Trichoscopy in Dermatomyositis—A Cross-Sectional Study

Journal of Clinical Medicine ◽

10.3390/jcm11020375 ◽

2022 ◽

Vol 11 (2) ◽

pp. 375

Author(s):

Magdalena Żychowska ◽

Adam Reich

Keyword(s):

Diagnostic Technique ◽

Skin Lesions ◽

Cross Sectional Study ◽

Cutaneous Lesions ◽

Cross Sectional ◽

Cutaneous Manifestations ◽

Non Invasive ◽

Inflammatory Dermatoses ◽

Curved Vessels ◽

Established Role

Background: (Video)dermoscopy is a non-invasive diagnostic technique that has a well-established role in dermatooncology. In recent years, this method has also been increasingly used in the assessment of inflammatory dermatoses. So far, little is known about the (video)dermoscopic features of dermatomyositis (DM). Methods: Consecutive patients with DM were included in the study and videodermoscopic assessments of the nailfolds, scalp, and active skin lesions were performed. Results: Fifteen patients with DM (10 women and 5 men) were included. Capillaroscopy showed elongated capillaries (90.9%), avascular areas (81.8%), disorganized vessel architecture (81.8%), tortuous capillaries (72.7%), dilated capillaries (72.7%), and hemorrhages (72.7%). The trichoscopic findings included linear branched vessels (80.0%), linear vessels (60.0%), linear curved vessels (53.3%), perifollicular pigmentation (40.0%), perifollicular erythema (33.3%), scaling (20.0%), white (20.0%) or yellow (20%) interfollicular scales, and white (20.0%) or pinkish (13.3%) structureless areas. Polymorphic vessels of an unspecific distribution and white or pink structureless areas were frequently observed under dermoscopy in cutaneous manifestations of DM, including Gottron’s papules and Gottron’s sign. Conclusions: Dermoscopy of the nailfolds (capillaroscopy), scalp (tricoscopy), and active cutaneous lesions may be of value in the preliminary diagnosis of DM.

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