摘要
Introduction. Superficial granulomatous pyoderma is a rare variant of pyoderma gangrenosum, which is often diagnosed at a late stage because of misleading cli nical-histopathological features. We report a new case of this rare disease. Ca se report. A 67 year-old man presented with inflammatory lesions that had becom e ulcerated over the past 4 months despite prolonged antibiotic therapy. The his topathological aspect was initially suggestive of palisading granuloma annulare and subsequently a necrotizing granuloma compatible with a mycobacteriosis. The various supplementary examinations eliminated the possibility of an infectious o r systemic disease. The lesions became painful and ulcerated. A second biopsy sh owed a neutrophilic dermatosis with dermal necrosis and a granuloma leading to t he diagnosis of superficial granulomatous pyoderma. The lesions healed after 3 m onths of systemic corticosteroids at the dose of 1 mg/kg/day. Discussion. The cl inical features of superficial granulomatous pyoderma are similar to those of cl assical pyoderma gangrenosum. However, its histological profile is more superfic ial and is associated with dermal granulomas. The latter are unusual in neutroph ilic dermatosis and would suggest an infectious disease. This explains the frequ ent diagnostic errors, with inappropriate anti-infectious treatments and notabl y unnecessary surgical exeresis.
Introduction. Superficial granulomatous pyoderma is a rare variant of pyoderma gangrenosum, which is often diagnosed at a late stage because of misleading cli nical-histopathological features. We report a new case of this rare disease. Ca se report. A 67 year-old man presented with inflammatory lesions that had becom e ulcerated over the past 4 months despite prolonged antibiotic therapy. The his topathological aspect was initially suggestive of palisading granuloma annulare and subsequently a necrotizing granuloma compatible with a mycobacteriosis. The various supplementary examinations eliminated the possibility of an infectious o r systemic disease. The lesions became painful and ulcerated. A second biopsy sh owed a neutrophilic dermatosis with dermal necrosis and a granuloma leading to t he diagnosis of superficial granulomatous pyoderma. The lesions healed after 3 m onths of systemic corticosteroids at the dose of 1 mg/kg/day. Discussion. The cl inical features of superficial granulomatous pyoderma are similar to those of cl assical pyoderma gangrenosum. However, its histological profile is more superfic ial and is associated with dermal granulomas. The latter are unusual in neutroph ilic dermatosis and would suggest an infectious disease. This explains the frequ ent diagnostic errors, with inappropriate anti-infectious treatments and notabl y unnecessary surgical exeresis.
