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Andy Wells
Andy Wells3 months ago
Pyoderma Gangrenosum

Pyoderma Gangrenosum

A 5-year-old boy with a history of IgA vasculitis at 2 years of age was admitted to the hospital with a 2-month history of nasal lesions (which were abating) and a 1-month history of progressively painful skin ulcerations. He had recently been hospitalized for the nasal lesions, which had a pustular appearance and were presumed to be abscesses. The lesions did not initially resolve with antimicrobial therapy and surgical débridement but had started scabbing after 2 days of therapy with systemic glucocorticoids. Soon after, however, new skin ulcerations appeared on his limbs, for which he returned to the hospital. On examination, the left forearm (Panel A) and right calf (Panel B) had sharply demarcated skin ulcerations with an erythematous base and purple border. The dorsum of the right foot also had a scabbed lesion with an indurated, purple border (Panel C). The nasal vestibule had areas of scarring but no pustules or ulcers. Laboratory and radiographic studies showed no signs of underlying systemic disease, such as cancer, inflammatory bowel disease, or autoimmune conditions. Biopsy samples from all three lesions showed a dense neutrophilic infiltrate with negative tissue cultures. A diagnosis of pyoderma gangrenosum was made. After 8 months of treatment with tapering doses of glucocorticoids, the lesions had resolved completely. Hai-yan Zhou, M.D. Ze-Hu Liu, M.D. Hangzhou Third People’s Hospital, Hangzhou 310009, China source: nejm.org

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