Pyoderma Gangrenosum with Oral Involvement–Case Report and Review of the Literature

Pyoderma gangrenosum （PG） is a rare, noninfectious neutrophilic dermatosis. Clinically, it begins with sterile pustules that rapidly progress into painful ulcers of variable depth and size with undermined violaceous borders. The diagnosis of PG is based on the history of an underlying disease, a typical clinical presentation, histopathology, and exclusion of other diseases. The peak incidence occurs between the ages of 20 to 50 years with women being more often affected than men. There have been very few reports of pyoderma gangrenosum with oral mucosal involvement. Oral lesions in previously reported cases have included ulcers of varying sizes from a few mm to several cm and have been reported to have been found on the tongue, soft and hard palate, buccal mucosa, and gingiva. Some of these oral lesions have been associated with ulcerative colitis, inflammatory bowel disease, and polycythemia rubra vera. A few cases were reported with biopsy findings, the histological picture being nonspecific, showing ulceration, and necrosis with inflam- matory cell infiltrate. A peculiar case of pyoderma gan- grenosum with an oral lesion is presented here, and the differential diagnosis is discussed.

Successful use of adalimumab for treating fistulizing Crohn's disease with pyoderma gangrenosum:Two birds with one stone

Crohn＇s disease （CD） is a chronic relapsing and remitting autoinflammatory disorder of the gastrointestinal tract that has many intestinal and extraintestinal complications. The purpose of treatment is long-term remission, reduction of complications, and improvement of patients＇ quality of life. In many cases, this can be quite challenging and it is necessary to have a well thought out management strategy. We present the case of a 38-year-old woman with fistulizing CD that manifested as diffuse abdominal pain and bloody diarrhea accompanied by arthralgia. In addition, there were ulcerative lesions surrounded by cutaneous inflammation and erythema on her extremities, indicative of pyoderma gangrenosum. The patient was treated with high doses of parenteral methylprednisolone without any improvement and was started on adalimumab. A positive response to adalimumab therapy was observed： after 2 mo of therapy, the ulcerative skin lesion healed completely and the enterogastric fistula was closed affcer 5 mo adalimumab treatment. Adalimumab might be a suitable initial as well as maintenance therapy in patients with complicated CD.

Pyoderma gangrenosum confused with congenital preauricular fistula infection: A case report

BACKGROUND Pyoderma gangrenosum resulting from or associated with congenital preauricular fistula is rarely reported.CASE SUMMARY We report a rare case of pyoderma gangrenosum misdiagnosed as preauricular fistula infection.To our knowledge,this is the first report to describe pyoderma gangrenosum originating from the site of preauricular fistula.The lesion continued expanding even after combined treatment of systemic antibiotics and thorough debridement.Taking into account the possibility of pyoderma gangrenosum,we applied soft care with normal saline and Vaseline gauze dressing.Systemic corticosteroids were not used until intestinal Clostridium difficile was controlled.No local recurrence was noted at the 12-mo follow-up.CONCLUSION This case highlights the necessity of considering rare diseases,such as pyoderma gangrenosum,when the preauricular sinus deteriorates with general management.The treatment strategy is mutually conflicting between pyoderma gangrenosum and infection of the preauricular sinus.

Intestinal Behcet's disease with pyoderma gangrenosum:A case report

We report here a very rare case of intestinal Behcet＇s disease with pyoderma gangrenosum. A 16-year-old woman who was diagnosed with intestinal Behcet＇s disease by the presence of cutaneous pathergy together with two major criteria （oral and genital aphthoses） and one minor criterion （gastrointestinal manifestations）, was referred to our hospital with a left lower leg ulcer and abdominal pain in September 1989. Colonoscopy demonstrated flare-up colitis involving the entire colon. Her lower leg lesion was a painful destructive ulcer with an irregular margin and a ragged overhanging edge. Based on these clinical and laboratory findings, we diagnosed her cutaneous ulcer as pyoderma gangrenosum developing with exacerbated intestinal Behcet＇s disease. Her cutaneous and intestinal lesions were poorly controlled though she received oral prednisolone treatment for a month. Because of aggravated abdominal symptoms with peritoneal irritation, we performed total colectomy in November 1989. The resected specimen was histologically compatible with intestinal Behcet＇ s disease showing severe inflammation with deep ulcerations and neutrophil accumulation. Subsequently, pyoderma gangrenosum rapidly improved. This clinical course may suggest the close relationship between pyoderma gangrenosum and intestinal Behcet＇s disease.

Successful treatment of pyoderma gangrenosum with concomitant immunoglobulin A nephropathy: A case report and review of literature

Pyoderma gangrenosum(PG)is an uncommon ulcerative cutaneous condition of an unknown etiology and is often associated with immune diseases.However,PG rarely shows visceral involvement,especially in the kidney.A 20-year-old female presented with pedal edema and skin ulceration of both lower limbs.The skin lesion began as an erythematous plaque and then became a blister.She also complained of abdominal distension and a decreasing urine volume.Laboratory data showed high proteinuria,hypoalbuminemia and hyperlipidemia.Her skin and kidney were biopsied.The pathological results indicated PG and immunoglobulin A(IgA)nephropathy.The patient was finally cured with prednisolone in combination with cyclosporine A(CsA).

Acute Lymphoblastic Leukemia in Childhood Following Pyoderma Gangrenosum

Pyoderma gangrenosum (PG) is a rare but serious ulcerating skin disease that occurs either idiopathically or associated with various systemic diseases and malignant tumors. Although the association of PG with myeloid malignant tumors is well known, their association with lymphoid malignant tumors, especially in children is extremely rare. We present here a case of PG in a 4-year and 4 months female child, diagnosed in the Pediatrics department, which had initially evolved well with oral corticosteroid therapy and a local dermocorticoid. The development was marked 7 months after stopping corticosteroid treatment by the occurrence of acute lymphoblastic leukemia. This case of PG is presented in the intention of increasing awareness of this uncommon condition with may occurring in association with haematological malignancy. PG may precede, develop concurrently with, or follow various conditions.

Cytapheresis for pyoderma gangrenosum associated with inflammatory bowel disease:A review of current status

Pyoderma gangrenosum(PG)is a neutrophilic dermatosis clinically characterized by the presence of painful skin ulcerations with erythematous.As it is frequently associated with inflammatory bowel diseases,including ulcerative colitis,gastroenterologists should be familiar with the disease including therapeutic options.Therefore,we have conducted a review focusing on the cytapheresis for PG in cases of inflammatory bowel diseases.A literature search was conducted to extract studies published in the last 20 years,with information on demographics,clinical symptoms,treatment,and the clinical course from a total of 22 cases reported and our recent case.In most patients,cytapheresis was associated with improvement or resolution of PG after failure of conventional therapeutic options such as corticosteroids,antibiotics,immunosuppressive agents and immunoglobulin.Based on the information summarized,cytapheresis is helpful in the majority of patients with PG refractory to medical treatment associated with inflammatory bowel diseases and could be further studied in a multicenter,randomized trial.

Nasal mucosa pyoderma vegetans associated with ulcerative colitis:A case report

BACKGROUND Pyoderma vegetans(PV)is not a common extra-intestinal manifestation of ulcerative colitis(UC),while nasal mucosa PV associated with UC is particularly rare.CASE SUMMARY We report a 28-year-old female with a history of UC and pyoderma gangrenosum who presented with nasal pain.A nasal lesion could be observed in her nose,and histopathological examination was indicative of PV.The patient was treated with oral prednisone(40 mg per day)with good response and became symptomatically free.There was no recurrent attack after 1 year of follow-up.CONCLUSION Inflammatory bowel disease patients presenting with nasal pain should be further investigated to rule out the coexistence of nasal mucosa PV.

Diagnostic dilemma between intestinal Behet disease and inflammatory bowel disease with pyoderma gangrenosum

TO THE EDITOR I have read with great interest the very recent article rifled ＂Intestinal Behcet＇s disease with pyoderma gangrenosum： A case report＂ of Nakamura T et al that was published in your journal. The authors stated that they presented a very rare case of intestinal Behcet＇s disease with pyoderma gangrenosum in a 16-year old patient. However, I would like to make some important contributions and suggestions to the presented case and have a few questions to ask the authors.

Pyogenic arthritis,pyoderma gangrenosum,and acne syndrome in a Chinese family:A case report and review of literature

BACKGROUND Pyogenic arthritis,pyoderma gangrenosum,and acne(PAPA)syndrome is a rare autosomal dominant genetic disease characterized by severe autoimmune inflammation,caused by mutations in the PSTPIP1 gene.Due to PAPA heterogeneous clinical manifestation,misdiagnosis or delayed diagnoses are difficult to avoid.With the use of whole-exome sequencing,we identified a missense mutation in the PSTPIP1 gene in a Chinese family.To the best of our knowledge,this is the first case of PAPA reported in China.CASE SUMMARY A 9-year-old boy suffered from recurrent aseptic pyogenic arthritis triggered by minor trauma or few obvious predisposing causes for more than 3 years.Pyogenic arthritis occurred every 3-5 mo,affecting his knees,elbows,and ankle joints.Treatments,such as glucocorticoids,antibiotics,even surgeries could alleviate joints pain and swelling to some extent but could not inhibit the recurrence of arthritis.Similar symptoms were present in his younger brother but not in his parents.According to the whole-exome sequencing,a missense mutation in exon 11 of the PSTPIP1 gene(c.748G>C;p.E250Q)was detected in the boy,his young-er brother and his father.Taking into account the similar phenotypic features with PAPA syndrome reported previously,we confirmed a diagnosis of PAPA syndrome for the family.CONCLUSION In this case,a missense mutation(c.748G>C;p.E250Q)in PSTPIP1 gene was identified in a Chinese family with PAPA syndrome.Previous studies emphasize the fact that PAPA syndrome is hard to diagnose just through the clinical manifestations owing to its heterogeneous expression.Genetic testing is an effectual auxiliary diagnostic method,especially in the early stages of pyogenic arthritis.Only if we have a deep understanding and rich experience of this rare disease can we make a prompt diagnosis,develop the best clinical treatment plan,and give good fertility guidance.

Pyoderma gangrenosum affecting the mouth

Pyoderma gangrenosum is a rare ulcerative cutaneous disorder commonly associated with systemic diseases such as inflammatory bowel diseases. This paper reports a case of pyoderma gangrenosum affecting the mouth and the skin associated with ulcerative colitis. A Medline search in English literature from 1961 to 2012 revealed only 11 documented cases of pyoderma gangrenosum with oral involvement. Previous reported cases of oral cavity involvement have shown that the most common sites of manifestation are the tongue, palate, and tonsillar fauces. This case emphasizes the importance of including inflammatory bowel diseases and their manifestations in the differential diagnosis of ulcerative lesions in the oral cavity.

Pyoderma gangraenosum-like fungal disease caused by Fusarium solani

A case of pyoderma gangraenosum-like fungal disease caused by Fusarium solani is described. The left upper eyelid ofthe patient was injured by a splashing iron sliver before fungal infection. No detectable immunodeficiency was found. The patientwas cured with topical therapy of amphotericin B(0.5% solution) and intravenous flucytosine.

1例青少年女性乳房巨大溃疡坏疽性脓皮病病人的护理

总结1例青少年女性乳房巨大溃疡脓皮病病人的护理经验,护理要点包括根据疾病的不同时期及伤口的不同愈合阶段,实施针对性的护理创面措施促进伤口愈合;适时进行疼痛管理,提高病人舒适度;关注病情及用药护理,防止并发症;及时进行心理评估,加强心理干预。病人经28 d的治疗与护理,病情好转后出院,门诊随访病情稳定,创面愈合良好。

坏疽性脓皮病治疗进展

坏疽性脓皮病(PG)是一种以皮肤出现复发性、疼痛性及坏死性溃疡为特征的嗜中性皮病。目前尚无PG治疗的共识,且治疗困难。既往糖皮质激素为临床上常用的一线治疗药物,免疫抑制剂等其他传统药物可单独或联合糖皮质激素使用,但部分患者仍难以取得满意疗效。近年来生物制剂及小分子靶向药物逐渐应用于该病的治疗并取得了一定的疗效。本文主要对近年来治疗PG的生物制剂、JAK抑制剂等靶向药物的疗效和安全性进行综述,为临床治疗提供参考。

依奇珠单抗治疗坏疽性脓皮病一例并文献复习

坏疽性脓皮病是一种少见的嗜中性皮肤病,其发病机制目前尚不完全清楚,传统治疗包括系统应用糖皮质激素及环孢素、环磷酰胺等免疫抑制剂,但常规药物疗效并不十分令人满意。近年来,随着生物制剂在皮肤科领域的广泛应用,国外有越来越多超适应症应用生物制剂治疗坏疽性脓皮病的经验报道。现报道IL-17A抑制剂依奇珠单抗治疗坏疽性脓皮病一例,并对既往文献进行复习。

MAP3K7、MPO基因与中国人群坏疽性脓皮病发病的相关性研究

目的:对中国人群坏疽性脓皮病患者进行基因检测,明确相关突变。方法:收集坏疽性脓皮病患者外周血,提取DNA并进行目标基因二代测序,使用样本库中对照样本全外显子数据进行基因负荷检验,并对可能与坏疽性脓皮病发病相关的突变位点使用Sanger测序验证。结果:共收集36例坏疽性脓皮病患者,在4例患者的5个基因中发现了6个有害性突变位点。包括一个移码突变:NLRP12:c.908delT(p.F303fs)和5个错义突变:MAP3K7:c.815C>G(p.S272C),MPO:c.1484C>T(p.T495I),MPO:c.1705C>T(p.R569W),NOD2:c.2975G>A(p.R992Q),SYK:c.389A>G(p.E130G)。其中MAP3K7的杂合突变和MPO的纯合(复合杂合)突变仅存在于病例组。结论:本研究发现了MAP3K7(P=7.44E-02),MPO(P=7.44E-02)有害性突变可能与中国人群的坏疽性脓皮病相关。

阿达木单抗联合糖皮质激素治疗复发难治性坏疽性脓皮病一例

本文报道一例患有坏疽性脓皮病17年的患者,该患者先后18次于我科住院治疗,曾使用糖皮质激素、免疫抑制剂、益赛普、沙利度胺等药物及物理治疗,皮肤溃疡可好转,但仍有反复。半月前患者病情加重,给予糖皮质激素联合阿达木单抗治疗,2周后溃疡变浅出院。出院后口服甲泼尼龙50 mg每日1次,逐渐减量,阿达木单抗40 mg,每2周1次,第4次注射阿达木单抗后溃疡大部分愈合。随访8个月,患者已停用糖皮质激素,阿达木维持治疗,皮损基本痊愈。

Comparison of Clinical Features between Pyoderma Gangrenosum Concomitant by Inflammatory Bowel Disease and Idiopathic Pyoderma Gangrenosum

Background： Pyoderma gangrenosum （PG） is a rare neutrophilic dermatosis that is highly associated with inflammatory bowel disease （IBD）. Certain PG patients with no systemic disorders have been diagnosed with idiopathic PG. This study sought to clarity/the difference between PG with IBD and idiopathic PG based on clinical features, laboratory tests, and medications. Methods： Twelve patients with PG and IBD and 24 patients with idiopathic PG, who were hospitalized in Peking Union Medical College Hospital from 2000 to 2017, were retrospectively categorized into the IBD group and control group, respectively. Data of clinical features, laboratory tests, and medications were collected and compared between the two groups. Results： Both groups were similar with respect to their clinical features. However, the IBD group had an increased occurrence of arthralgia or arthritis （58.3% vs. 12.5%, P = 0.007）, anemia （83.3% and 29.2%, P = 0.004）, and an increased percentage ofantineutrophilic cytoplasmic antibody （ANCA）-positive patients （85.7% and 0.0%, P 〈 0.001）, compared to the control group. Conclusion： PG patients with IBD had increased occurrence rates of arthralgia or arthritis, anemia, and ANCA-positive status compared to idiopathic PG patients.

坏疽性脓皮病的发病机制及治疗进展

坏疽性脓皮病是一种伴随罕见的疼痛性皮肤溃疡的嗜中性皮肤病。坏疽性脓皮病的发病机制复杂且尚未完全清楚,但目前研究表明其与中性粒细胞功能障碍、免疫功能失调、遗传易感性等有关。由于缺乏特异性生物标志物,坏疽性脓皮病的诊断难度较大,容易造成误诊,可根据Paracelsus评分诊断。目前坏疽性脓皮病的治疗以糖皮质激素和免疫抑制剂为主,生物制剂对坏疽性脓皮病的治疗具有广阔的应用前景。

一例重度溃疡性结肠炎合并肠外表现患者的药学监护

目的对1例重度溃疡性结肠炎合并坏疽性脓皮病、膝关节肿痛、踝关节肿痛患者的治疗方案进行分析,临床药师协助医生制定药物治疗与监护计划,保障患者用药安全、合理、有效。方法结合患者的疾病史,根据药物治疗效果及不良反应,与医生沟通药物的选择、用药剂量及药物使用原则,对患者治疗方案由英夫利西单抗转换为托法替布治疗的风险与获益进行评估,并对患者进行用药教育。结果临床药师从药学角度出发,参与临床治疗,优化药物治疗方案,提高了患者对疾病的认识和依从性,保障了用药安全。结论临床药师参与制定药学治疗方案和药学监护,为患者提供个性化的用药服务,提高临床用药的安全性、有效性,提升患者就医幸福感。