scholarly journals Giant idiopathic pyoderma gangrenosum at an unusual site with highly elevated c-ANCA levels: A rare association

2021 ◽  
pp. 58-61
Author(s):  
Lovleen Kaur ◽  
Mohita Mahajan ◽  
Parul Chojer ◽  
Bharat Bhushan Mahajan ◽  
Suresh Kumar Malhotral
Keyword(s):  
Pyoderma Gangrenosum ◽  
Rapid Progression ◽  
Intense Pain ◽  
Unusual Site ◽  
Early Management ◽  
Systemic Involvement ◽  
Patient Reported ◽  
Rate Of Progression ◽  
Left Buttock ◽  
Systemic Abnormality

Pyoderma gangrenosum (PG) is a rare neutrophilic disorder with an incidence rate of 3–10 cases per million per year, characterized by classically painful and aseptic ulcers, which may be associated with underlying systemic diseases. The pathergy reaction is seen in one-fourth of patients with PG. Accurate and timely diagnosis is crucial, as PG is known for its rapid progression. The management of PG is challenging and depends on its severity and rate of progression. An underlying systemic involvement should be sought even in spite of no symptoms. Herein, we report a case of giant pyoderma gangrenosum involving almost the entire left buttock with exceptionally raised c-ANCA levels, but no underlying systemic abnormality. The patient reported intense pain, rapid progression of the ulcers, an inability to perform daily activities, was significantly morbid and pathergy-positive. Aggressive and early management is required in cases such as this. A dramatic response was achieved with a combination of cyclosporine, dapsone, and methylprednisolone pulses.

scholarly journals Post-injection embolia cutis medicamentosa – Nicolau Syndrome: case report and literature review

2016 ◽  
Vol 15 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Carlos Alberto Araujo Chagas ◽  
Tulio Fabiano de Oliveira Leite ◽  
Lucas Alves Sarmento Pires
Keyword(s):  
Healthcare Professionals ◽  
Subcutaneous Tissue ◽  
Vascular Complication ◽  
Benzathine Penicillin ◽  
Intense Pain ◽  
Large Ulcer ◽  
Intramuscular Injections ◽  
Nicolau Syndrome ◽  
Left Buttock ◽  
Embolia Cutis Medicamentosa

Abstract We report on the case of a 40-year-old male who was admitted to the clinic with a large ulcer on his left buttock, 3 days after an intramuscular benzathine penicillin injection. The patient was diagnosed with Nicolau syndrome, a rare vascular complication in which a lesion develops after intramuscular injection. Symptoms are intense pain at the injection site, erythema, and livedoid dermatitis, which leads to necrosis of skin, subcutaneous tissue and muscle tissue. It was described by Nicolau after intramuscular injections of bismuth salt for syphillis therapy. Nicolau syndrome is rare, but its symptoms are devastating and healthcare professionals must be aware of this clinical entity, since intramuscular injections are common procedures for administration of drugs.

scholarly journals Pyoderma Gangrenosum: A Review of Clinical Features and Outcomes of 23 Cases Requiring Inpatient Management

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Mingwei Joel Ye ◽  
Joshua Mingsheng Ye
Keyword(s):  
Pyoderma Gangrenosum ◽  
Length Of Hospital Stay ◽  
Rapid Progression ◽  
High Morbidity ◽  
Systemic Diseases ◽  
Wound Infections ◽  
Inpatient Management ◽  
The Mean ◽  
Topical Treatments ◽  
Systemic Therapies

Pyoderma gangrenosum (PG) is a rare dermatological disorder characterised by the rapid progression of a painful, necrolytic ulcer. This study retrospectively identified patients who were admitted and treated for PG during a 10-year period (2003–2013). Twenty-three patients were included in this study, 16 women and seven men. The mean age at initial admission was 62.8 years (range 30 to 89 years). Lesions were localised to lower limb in 13 patients, peristomal region in four, breast in three, and upper limb in one, and two patients had PG at multiple sites. The variants of PG noted were ulcerative (18), bullous (2), vegetative (2), and pustular (1). Associated systemic diseases were observed in 11 patients (47.8%). Systemic therapies were initiated in 21 patients while two patients received topical treatments. The mean length of hospital stay was 47 days (range 5 to 243 days) and five patients died during their admissions. Seven patients required readmissions for exacerbations of their PG. Our study showed that patients admitted for treatment of PG had high morbidity and mortality. This study also highlights the importance of early and aggressive treatment of patients admitted with PG as well as treating associated systemic diseases and wound infections.

Pyoderma Gangrenosum with Systemic Involvement

1995 ◽  
Vol 22 (7) ◽  
pp. 515-519 ◽  
Author(s):  
Shoko Urano ◽  
Hiroyuki Kodama ◽  
Kazuaki Kato ◽  
Kazuya Nogura
Keyword(s):  
Pyoderma Gangrenosum ◽  
Systemic Involvement

scholarly journals Long-Term Sports Participation and Satisfaction After UCL Reconstruction in Amateur Baseball Players

2021 ◽  
Vol 9 (8) ◽  
pp. 232596712110275
Author(s):  
Robert A. Jack ◽  
Somnath Rao ◽  
Taylor D’Amore ◽  
Donald P. Willier ◽  
Robert Gallivan ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Case Series ◽  
Sports Participation ◽  
High Rate ◽  
Return To Play ◽  
Baseball Players ◽  
Patient Reported ◽  
Rate Of Progression

Background: While the incidence of ulnar collateral ligament reconstruction (UCLR) has increased across all levels of play, few studies have investigated the long-term outcomes in nonprofessional athletes. Purpose: To determine the rate of progression to higher levels of play, long-term patient-reported outcomes (PROs), and long-term patient satisfaction in nonprofessional baseball players after UCLR. Study Design: Case series; Level of evidence, 4. Methods: We evaluated UCLR patients who were nonprofessional baseball athletes aged <25 years at a minimum of 5 years postoperatively. Patients were assessed with the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC), the Timmerman-Andrews (T-A) Elbow score, the Mayo Elbow Performance Score (MEPS), and a custom return-to-play questionnaire. Results: A total of 91 baseball players met the inclusion criteria, and 67 (74%) patients were available to complete the follow-up surveys at a mean follow-up of 8.9 years (range, 5.5-13.9 years). At the time of the surgery, the mean age was 18.9 ± 1.9 years (range, 15-24 years). Return to play at any level was achieved in 57 (85%) players at a mean time of 12.6 months. Twenty-two (32.8%) of the initial cohort returned to play at the professional level. Also, 43 (79.1%) patients who initially returned to play after surgery reported not playing baseball at the final follow-up; of those patients, 12 reported their elbow as the main reason for eventual retirement. The overall KJOC, MEPS, and T-A scores were 82.8 ± 18.5 (range, 36-100), 96.7 ± 6.7 (range, 75-100), and 91.9 ± 11.4 (range, 50-100), respectively . There was an overall satisfaction score of 90.6 ± 21.5 out of 100, and 64 (95.5%) patients reported that they would undergo UCLR again. Conclusion: In nonprofessional baseball players after UCLR, there was a high rate of progression to higher levels of play. Long-term PRO scores and patient satisfaction were high. The large majority of patients who underwent UCLR would undergo surgery again at long-term follow-up, regardless of career advancement.

scholarly journals International Dermatology Outcome Measures (IDEOM): Report from the 2020 Annual Meeting

Dermatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Alison H. Kohn ◽  
Afsaneh Alavi ◽  
April W. Armstrong ◽  
Folawiyo Babalola ◽  
Amit Garg ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Annual Meeting ◽  
Outcome Measures ◽  
Pyoderma Gangrenosum ◽  
Actinic Keratosis ◽  
Hidradenitis Suppurativa ◽  
Outcome Measurements ◽  
Dermatological Disease ◽  
Patient Reported ◽  
The Impact

<b><i>Background:</i></b> The International Dermatology Outcome Measures (IDEOM) initiative is a non-profit organization that aims to develop evidence-based outcome measurements to evaluate the impact of treatments for patients with dermatological disease. IDEOM includes all key stakeholders in dermatology (patient, physician, industry, insurer, and government) during the process of developing such outcome measurements. <b><i>Summary:</i></b> Here, we provide an update of IDEOM activities that were presented at the 2020 IDEOM Virtual Annual Meeting (October 23–24, 2020). During the meeting, multiple IDEOM workgroups (psoriasis, psoriatic arthritis, hidradenitis suppurativa, acne, pyoderma gangrenosum, and actinic keratosis) shared their progress to date, as well as future directions in developing and validating Patient-Reported Outcome Measures. Updates on demonstrating efficacy in clinicals trials by the US Food and Drug Administration are also summarized. <b><i>Key Messages:</i></b> In this report, we summarize the work presented by each IDEOM workgroup (psoriasis, psoriatic arthritis, hidradenitis suppurativa, acne, pyoderma gangrenosum, and actinic keratosis) at the 2020 IDEOM Virtual Annual Meeting.

Implementation of telemedicine in cancer clinical trials: Connectpatienttodoctor study. (Preprint)

2021 ◽  
Author(s):  
Yasmine MEGHIREF ◽  
Charles Parnot ◽  
Claire DUVERGER ◽  
Françoise DIFOUM ◽  
Audrey Gourden ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Remote Monitoring ◽  
Routine Care ◽  
Health Care Team ◽  
Digital Tool ◽  
Early Management ◽  
Median Response ◽  
Patient Reported ◽  
High Level

BACKGROUND Telemedicine is currently being adopted for the management of patients in routine care. However, its use remains limited in the context of clinical trials. OBJECTIVE The Connectpatienttodoctor study aims to evaluate a connected telemonitoring platform, Haya by Cureety, in cancer patients included in clinical trials. METHODS Patients included in an interventional oncology clinical trial were eligible. Patients were registered with a digital tool to respond to a patient reported outcomes (ePRO) questionnaire based on CTCAE v.5.0, personalized to their pathology and treatment. An algorithm evaluates the health status of the patient based on the reported adverse events (AEs), with a classification in four different states (Correct, Compromise, State to be monitored or Critical State). The main objective was to evaluate the feasibility of remote monitoring via a connected platform of patients included in a clinical trial. RESULTS From July 1, 2020, to March 31, 2021, 39 patients were included. The median age was 71 years (range, 41-94), 74% were male, and 59% had metastatic disease. Out of 969 ePRO questionnaires completed over the course of the study, 77% were classified as "correct", 11% as "compromised" and 12% as "to be monitored" or “critical”. The median response time was 7 days (IQR 7-15.5) and 76% of patients (n=25/33) were compliant. Out of the 35 patients who answered a satisfaction questionnaire, 95% (n=33) were satisfied or very satisfied with the tool, 85% (n=30) were satisfied with their relationship with the health care team. There were 5 unscheduled hospitalizations during the study period. CONCLUSIONS Remote monitoring in clinical trials is feasible, with a high level of patient participation and satisfaction. It benefits them but also ensures the quality of the trial, through early management of AEs and better knowledge of the tolerance profile of experimental treatments. This e-technology will likely be deployed more widely in our clinical trials.

Pyoderma Gangrenosum after Cardiac Surgery

2021 ◽  
Author(s):  
Asen Petrov ◽  
Utz Kappert ◽  
Torsten Schmidt ◽  
Klaus Ehrhard Matschke ◽  
Manuel Wilbring
Keyword(s):  
Cardiac Surgery ◽  
Surgical Site Infection ◽  
Pyoderma Gangrenosum ◽  
Severe Pain ◽  
Wound Closure ◽  
Clinical Presentation ◽  
Correct Diagnosis ◽  
Rapid Progression ◽  
Site Infection ◽  
Case Mortality

Abstract Background Pyoderma gangrenosum after cardiac surgery is a rare, noninfectious ulcerating skin disease mimicking sternal wound infection. Methods A systematic search of literature for pyoderma gangrenosum complicating cases of cardiac surgery was conducted between September 1985 and September 2020 on PubMed and Cochrane databases. A systematic review and detailed overview of clinical presentation, diagnostic, treatment, and outcome is provided. Results A total of 15 studies enclosing 15 patients suffering from pyoderma gangrenosum following cardiac surgery were identified. Onset of symptoms was observed after a median of 5 days. Patients were predominantly male (81.3%) with a median age of 64 years. Typical clinical presentation mimicked sternal site infection, mainly by means of mediastinitis. Specific signs were rapid progression, erythematous to violaceous color of the wound border, accompanied by unspecific symptoms including fever, malaise, and severe pain. Additionally, pathergy (development of ulcers at the sites of minor cutaneous trauma) was reported frequently. Biopsy is mandatory with a cutaneous neutrophilic inflammation confirming the diagnosis. Initial treatment mostly (75.0% of reported cases) was misled, addressing suspicion of surgical site infection. After correct diagnosis, the treatment was switched to an immunosuppressive therapy. Full sternal wound closure took between 5 weeks and 5 months. Reported case mortality was 12.5% in actually low-risk surgeries. Conclusion Despite pyoderma gangrenosum has typical signs, it remains an exclusion diagnosis. The treatment is completely opposite to the main differential diagnosis—the typical surgical site infection. Knowledge about diagnosis and treatment is essential in the context of avoiding fatal mistreatment.

scholarly journals Application and Benefits of Web-Mediated Symptom Reporting for Patients Undergoing Immunotherapy: A Clinical Example

2018 ◽  
Vol 11 (3) ◽  
pp. 763-768 ◽  
Author(s):  
Fabrice Denis ◽  
Bridget F. Koontz ◽  
Christophe Letellier
Keyword(s):  
Patient Reported Outcomes ◽  
Tumor Response ◽  
Response Assessment ◽  
Symptom Reporting ◽  
Web Based ◽  
Early Management ◽  
Patient Reported ◽  
Global Status ◽  
Events Detection

Two randomized studies of symptom monitoring during chemotherapy or during second line treatment and follow-up via web-based patient-reported outcomes (PROs) was previously demonstrated to lengthen survival. We are presenting here a patient with advanced and recurrent lung cancer who was followed for 4 years by PROs for relapse and adverse events detection. We report how the web-mediated follow-up helped to detect dangerous pulmonary embolism, relapse and pseudo-progression to immunotherapy by self-reported symptom tracking and specific algorithms triggering notifications to medical team, allowing early management of events. We particularly describe how a discordance between objective clinical improvement under immunotherapy assessed by the application allowed to detect pseudo-progression on imaging and allowed maintenance of the treatment during more than 1-year, although imaging report could have led to stop an effective therapy. The progression observed in the routine imaging was indeed in clear contradiction with improvements in patient’s global status as assessed by the reduced PRO-score computed from patient self-reported symptoms. The ability of e-health tools based on symptoms reporting for tumor response assessment should be assessed in trials to help physician in decision of stopping or continuing therapy.

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