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 Breast cancer and pyoderma gangrenosum: a complication after conservative surgery and radiotherapy

Mastology ◽  
2020 ◽  
Vol 30 ◽  
Author(s):  
Flávia Kuroda ◽  
Cicero Urban ◽  
Erica Mendes ◽  
Anelise Rocha Raymundo ◽  
Alessandra Amatuzzi Cordeiro Fornazari ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Diagnosis ◽  
Pyoderma Gangrenosum ◽  
Adjuvant Radiotherapy ◽  
Treatment Effectiveness ◽  
Conservative Surgery ◽  
Neutrophilic Dermatosis ◽  
Systemic Diseases ◽  
Pathergy Phenomenon

Pyoderma gangrenosum (PG) is a rare, ulcerative, and painful neutrophilic dermatosis of unknown cause associated with systemic diseases and/or pathergy phenomenon in 30% of cases. We report the case of a breast cancer patient submitted to oncoplastic conservative surgery followed by adjuvant radiotherapy, with long-term progression to PG. It’s rare and challeng ing nature reinforces the need for early diagnosis to increase treatment effectiveness and reduce morbidity.

scholarly journals UNILATERAL PYODERMA GANGRENOSUM OF THE EXTERNAL EAR IN A RESOURCE LIMITED SETTING: CASE REPORT AND LITERATURE REVIEW

2020 ◽  
Author(s):  
Zephania Abraham ◽  
Edwin Thomas ◽  
Aveline Kahinga
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Pyoderma Gangrenosum ◽  
Resource Limited Setting ◽  
Neutrophilic Dermatosis ◽  
External Ear ◽  
Prompt Treatment ◽  
Resource Limited ◽  
High Index Of Suspicion ◽  
Limited Setting

Pyoderma gangrenosum (PG) being a primary sterile neutrophilic dermatosis, the etiology is still uncertain and it rarely affects children. A high index of suspicion is essential to execute its prompt treatment. To the best of our knowledge this is the first reported case in our country

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.

Pyoderma Gangrenosum-Like Presentation of Herpetic Panniculitis in a Patient With Immunosuppression

2021 ◽  
Vol 33 (5) ◽  
pp. E39-E41
Author(s):  
Victoria Orfaly ◽  
Erika Hagstrom ◽  
Kevin White ◽  
Alex Ortega-Loayza
Keyword(s):  
Skin Biopsy ◽  
Pyoderma Gangrenosum ◽  
Herpes Virus ◽  
Immunocompromised Patient ◽  
Standard Of Care ◽  
High Index ◽  
Intralesional Corticosteroid ◽  
Standard Of Care Treatment ◽  
Herpès Virus ◽  
High Index Of Suspicion

Introduction. This case of herpes virus–induced panniculitis originally diagnosed as pyoderma gangrenosum (PG) illustrates the need for a high index of suspicion for atypical causes of cutaneous ulcers in patients who are immunocompromised. Case Report. A 79-year-old male presented with a 3-month history of a painless chronic ulcer on the left buttock that was refractory to antibiotic therapy and intralesional corticosteroid. The medical history was notable for diabetes mellitus type 2 and rheumatoid arthritis managed with long-term methotrexate and low-dose prednisone. Because the patient initially had a painful and enlarging skin ulcer after intralesional treatment with corticosteroids, an undermined and violaceous ulcer, and an autoimmune condition, PG was suspected at the initial evaluation. A subsequent skin biopsy to complete the workup confirmed the unexpected diagnosis of herpetic panniculitis. The patient was started on antiviral therapy; a prolonged therapeutic and suppressive dose was required. This case highlights the importance of skin biopsy in the diagnosis of chronic ulcers to rule out infectious etiologies. Maintaining a high index of suspicion for rare causes of cutaneous ulcers in the patient with immunosuppression is paramount. Conclusions. Herpes virus infection is only one atypical cause of ulcerative nodules in the immunocompromised patient. Skin biopsy should be considered in the immunocompromised patient with presumed PG that is not responding to standard of care treatment.

scholarly journals Varicella Zoster Virus-Associated Meningitis as a Rebound Varicella Zoster Disease after Antiviral Discontinuation

2021 ◽  
pp. 148-153
Author(s):  
Tetsuko Sato ◽  
Takenobu Yamamoto ◽  
Yumi Aoyama
Keyword(s):  
Herpes Zoster ◽  
Early Diagnosis ◽  
Varicella Zoster Virus ◽  
Immunosuppressive Therapy ◽  
Unusual Case ◽  
Cranial Nerves ◽  
Skin Lesions ◽  
Immunocompromised Patients ◽  
Aggressive Treatment ◽  
Varicella Zoster

Varicella zoster virus (VZV)-associated meningitis is usually progressive and can be fatal, and early diagnosis and aggressive treatment with intravenous antivirals such as acyclovir (ACV) are required in immunocompromised patients. Patients receiving corticosteroids and immunosuppressive therapy have a significantly higher risk of VZV-associated meningitis. In this report, we describe an unusual case of herpes zoster (HZ) in a young woman who was first diagnosed during tapering of prednisone for dermatomyositis. The skin lesions affected the left L2 and L3 dermatomes, which is unusual in VZV-associated meningitis. Despite showing a good rapid response to antivirals, she developed VZV-associated meningitis immediately after discontinuation of ACV. This phenomenon is often called rebound VZV reactivation disease and occurs after discontinuation of antivirals. This case was notable in that the affected dermatomes were distant from the cranial nerves. Thus, progression of HZ to VZV reactivation-associated meningitis can occur even in appropriately treated HZ patients. Continuation of antivirals beyond 1 week in patients on immunosuppressive therapy may be associated with a decreased risk of severe rebound VZV disease, such as VZV-associated meningitis.

Wegener’s granulomatosis: diagnostic dilemma

2001 ◽  
Vol 115 (1) ◽  
pp. 46-47 ◽  
Author(s):  
A. Banerjee ◽  
J. M. Armas ◽  
J. H. Dempster
Keyword(s):  
Early Diagnosis ◽  
Wegener’S Granulomatosis ◽  
Systemic Disease ◽  
Wegener's Granulomatosis ◽  
The Body ◽  
Facial Nerve Paralysis ◽  
Diagnostic Dilemma ◽  
Nerve Paralysis ◽  
Atypical Presentations ◽  
High Index Of Suspicion

Wegener’s granulomatosis is a systemic disease characterized by a granulomatous lesion that can affect any organ throughout the body.This case-report illustrates the problem posed by a patient presenting with bilateral serous otitis media with marked sensorineural hearing loss, facial nerve paralysis and an atypical serological picture. The importance of early diagnosis and the protocol for the management of a patient with an uncertain diagnosis is discussed. Due to atypical presentations, only a high index of suspicion will ensure an early diagnosis.

Lessons Learnt in Health Management: Paediatric Spinal Tumours: A 6-year Retrospective Review from Central India

2021 ◽  
pp. 097206342110504
Author(s):  
Pranati Sharma ◽  
Shrikant V. Rege ◽  
Nilesh Jain
Keyword(s):  
Rare Disease ◽  
Surgical Resection ◽  
Medical Records ◽  
Spinal Metastasis ◽  
Public Awareness ◽  
Survival Rates ◽  
Central India ◽  
Neurological Status ◽  
Histopathological Diagnosis ◽  
Spinal Tumours

Background: From the management perspective, rare medical conditions do not attract enough attention, though their management can often be resource intensive. Increased awareness among health professionals can lead to early diagnosis of cases and prevention of complications leading to improved outcomes. Paediatric spinal tumours are rare disease entities with an annual incidence of approximately 1 per 1 million children. The profile of spinal tumours in the paediatric population is significantly different than that in adults. In this study we retrospectively analyse a heterogenous variety of paediatric spinal tumours which were treated at our institution over the last 6 years, with the goal of contributing to existing knowledge of this relatively rare disease entity. Methods: This retrospective study includes paediatric patients (under 18 years of age) who underwent surgery for primary spinal tumours from 2014 to 2019. The medical records were reviewed retrospectively and the information regarding clinical presentation, tumour location, operative findings, and postoperative status and functional outcome were analysed. The modified McCormick grade was used to assess the neurological status. Patients with spinal metastasis or incomplete medical records were excluded from the study. Results: Of 74 patients with primary spinal tumours operated at our centre between 2014 to 2019, a total of 8 patients (5 males and 3 females) who met the inclusion criteria were identified for the present study. The mean age of the patients included was 12.1±5.3 and the median follow-up period was 24 months. An improvement in the neurological status, as assessed by the modified McCormick grade, was seen in 37.5% of the patients. Three of the patients received adjuvant radiotherapy, post-surgical resection. A unique feature of this series was the wide variety of cases encountered, as each case had a different histopathological diagnosis, despite being limited by its sample size. Conclusion: Primary paediatric spinal cord tumours are rare, and surgical resection remains the treatment of choice. Adjuvant therapy is warranted in cases of high-grade lesions or recurrences. Through this study, we realised that due to its relative rarity and low incidence, a lack of public awareness can often lead to disproportionately increased morbidity and mortality. Prospective multi-centric studies can provide tools to help develop future management strategies for improved survival rates and reduced complications.

Unusual Nasogastric Tube Position Leading to Delay in Diagnosis of Tracheoesophageal Fistula

2021 ◽  
pp. 097321792110367
Author(s):  
Monika Kaushal ◽  
Saima Asghar ◽  
Ayush Kaushal
Keyword(s):  
Early Diagnosis ◽  
Nasogastric Tube ◽  
Common Type ◽  
X Ray ◽  
Delay In Diagnosis ◽  
Atypical Symptoms ◽  
Tube Position ◽  
Esophageal Pouch ◽  
High Index Of Suspicion ◽  
Surgical Unit

Aim: This case highlights the importance of high index of suspicion for early diagnosis and thorough clinical examination of a newborn with tracheoesophageal atresia and fistula. Case Report: We report a case of most common type of tracheoesophageal atresia with fistula where diagnosis was missed due to unusual gastric position of nasogastric tube. Nasogastric tube reached stomach in esophageal atresia with fistula, delaying the diagnosis and management of condition. After accidental removal of tube and failure to pass again raised suspicion and was confirmed with coiled tube in esophageal pouch in X-Ray chest. Baby shifted to surgical unit for treatment, fortunately baby recovered and discharged home after surgical correction. Conclusion: Tracheoesophageal atresia with fistula can present with atypical symptoms and unusual events, challenging the early diagnosis and treatment of common types of conditions. Other association like VACTERL should be looked for, in patients.

scholarly journals Ulcerative Colitis and Sweet’s Syndrome: A Case Report and Review of the Literature

2008 ◽  
Vol 22 (3) ◽  
pp. 296-298 ◽  
Author(s):  
Massud Ali ◽  
Donald R Duerksen
Keyword(s):  
Ulcerative Colitis ◽  
Immunosuppressive Therapy ◽  
Neutrophilic Dermatosis ◽  
Sweet’S Syndrome ◽  
Review Of The Literature ◽  
Neutrophilic Infiltration ◽  
Drug Induced ◽  
Sweet's Syndrome ◽  
History Of ◽  
Inflammatory Bowel

A 47-year-old man with a history of ulcerative colitis on prednisone and azathioprine was admitted to the hospital with a four-day history of fever, skin rash, arthralgias and leukocytosis. A skin biopsy demonstrated neutrophilic infiltration of the dermis that was consistent with Sweet’s syndrome. He improved after several days with an increase in his prednisone and azathioprine. Sweet’s syndrome is a rare cutaneous manifestation of inflammatory bowel disease, with approximately 40 cases reported in the literature. In a previously reported case of a patient with ulcerative colitis-associated Sweet’s syndrome who was on azathioprine at the time of the skin eruption, the azathioprine was stopped, raising the possibility of drug-induced Sweet’s syndrome. In the present case, the azathioprine was actually increased with complete resolution of the skin manifestations. This would support the theory that immunosuppressive therapy is the mainstay of therapy for this condition. In conclusion, Sweet’s syndrome is a neutrophilic dermatosis that is rarely associated with ulcerative colitis. It may occur while on immunosuppressive therapy and responds to an intensification of immunosuppression.

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