PYODERMA GANGRENOSUM

Diagnosis: PYODERMA GANGRENOSUM

Case submitted by Dr.Azeem Alam Khan to the dermRounds community.

Clinical Presentation

Clinical photograph(s) submitted for peer review and discussion.

Clinical History

Submitted by Dr.Azeem Alam Khan. Originally posted October 7, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Venous stasis ulcer • Ecthyma gangrenosum • Necrotizing fasciitis • Vasculitis • Sweet syndrome • Factitial ulcer • Squamous cell carcinoma • Antiphospholipid syndrome

Key Learnings

• Neutrophilic dermatosis — diagnosis of exclusion • Pathergy: lesions worsen with surgical debridement — avoid unnecessary surgery • Associated with IBD (ulcerative colitis > Crohn), rheumatoid arthritis, hematologic malignancies • Classic PG: rapidly expanding ulcer with violaceous undermined borders and purulent base • Cribriform scarring is characteristic of healed lesions • Biopsy shows dense neutrophilic infiltrate but is nonspecific

Tags: pyoderma, gangrenosum, dr.azeem alam khan