Pyoderma gangrenosum in a patient with Crohn’s disease: Case report and a review of the literature

Abstract

Pyoderma gangrenosum is a rare neutrophilic noninfec­tious dermatose. Etiopathogenesis remains unclear, but in half of cases, there is an associated underlying dis­ease. Inflammatory bowel disease is the most common underlying disorder. Systemic immunosuppressive or im­munomodulator drugs and some topical agents are used in treatment of pyoderma gangrenosum. Systemic corti­costeroids are the first-choice of treatment. We reported a case with Crohn\'s disease associated with pyoderma gangrenosum. She was successfully treated with oral methyl prednisolon. The case was a 54-year-old woman who admitted to hospital because of erythematous, pain­ful plaques on the right and left pretibial surfaces. She had a history of Crohn\'s disease, diabetes mellitus, and hypertension. An elevated white blood cell count (13500/μL) and high erythrocyte sedimentation rate (120 mm/h) were detected. A regime of broad-spectrum antibiotics was started, but response was poor. Histopathological assessment of biopsy specimens showed necrosis, se­vere edema and erythrocyte extravasations in superficial dermis, regenerative changes in adjacent epithelium, and mixed inflammatory reaction surrounding necrosis in the inner part of the dermis. Based on these clinical and labo­ratory findings, poor response to antibiotics and underly­ing disease; her skin lesions were considered as pyoder­ma gangrenosum. Oral methylprednisolone was started and her skin lesions improved. The steroid dose was ta­pered and finally stopped under outpatient follow-up. In conclusion, our patient also showed that corticosteroids continue to be the first-choice therapy in pyoderma gan­grenosum.

Keywords

• Pyoderma gangrenosum, Crohn\'s disease, corticosteroids.

Crohn hastalığında piyoderma gangrenosum: Olgu sunumu ve literatürün gözden geçirilmesi

Abstract

Piyoderma gangrenozum seyrek görülen ve enfeksiyöz olmayan bir nötrofilik cilt hastalığıdır. Etyolopatogenezi bi­linmemektedir. Olguların yarısında altta yatan bir hastalık mevcuttur. En sık inflamatuvar bağırsak hastalığına eşlik eder. Tedavisinde immün baskılayıcı veya immünmodüla­tör ilaçlarla bazı topikal ajanlar kullanılmaktadır. Sistemik kortikosteroidler, tedavide ilk seçenek ilaçlardır. Crohn hastalığı zemininde gelişmiş ve başarılı bir şekilde tedavi edilmiş olan bir piyoderma gangrenozum vakası sunuldu. Crohn hastalığı, diyabetes mellitus ve hipertansiyonu olan 54 yaşında bir kadın, her iki bacağın ön iç tarafında kırmı­zımsı ve ağrılı lezyonları nedeniyle hastanemize başvur­du. Anormal laboratuar bulgusu olarak lökositoz (13500/μL) ve artmış sedimantasyon hızı (120 mm/saat) tespit edildi. Geniş spektrumlu antibiyotik tedavisi başlanıldı, ancak beklenen cevap alınamadı. Lezyon biyopsisinden histopatolojik değerlendirme yapıldı. Üst dermiste nekroz, şiddetli ödem, eritrosit ekstravazasyonuyla çevre dokuda rejeneratif değişiklikler, dermisin iç bölümünde nekrozu kuşatan mikst inflamatuvar reaksiyon görüldü. Kliniği, laboratuvar bulguları ve altta yatan hastalığı piyoderma gangrenozumu düşündürdü. Oral metil prednizolon baş­lanıldı, lezyonlarında düzelme görülmesi üzerine taburcu edildi. Ayaktan takiplerinde kortikosteroid dozu tedricen azaltılarak kesildi. Vakamız, sistemik kortikosteroidlerin piyoderma gangrenozum tedavisinde hâlâ favori ilaçlar olduğunu göstermiştir.

Keywords

• Piyoderma gangrenozum, Crohn hastalığı, kortikosteroid.

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