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Fulltext Pyoderma gangrenosum

Tan WC, Ong CK, Lo KS, Leong KN

Med J Malaysia, 2007 Aug;62(3):251-3.
PMID: 18246920 MyJurnal

Pyoderma Gangrenosum (PG) is a non-infective, necrotising neutrophilic dermatosis. Many diseases may mimic PG. It may be idiopathic or may be associated with a systemic disorder. We report a case of PG in association with ulcerative colitis.

Matched MeSH terms: Pyoderma Gangrenosum/diagnosis; Pyoderma Gangrenosum/drug therapy; Pyoderma Gangrenosum/pathology*
Fulltext A novel therapy for the treatment of pyoderma gangrenosum

Azizan NZ, Gangaram HB, Hussein SH

Med J Malaysia, 2008 Mar;63(1):51-4.
PMID: 18935734 MyJurnal

Pyoderma gangrenosum (PG) is an uncommon, chronic, painful, ulcerative skin disease of unknown origin, often associated with systemic diseases including inflammatory bowel disease, rheumatoid arthritis; monoclonal gammopathy, hepatitis and myeloproliferative disorders. The mainstay of therapy for PG has been high-dose corticosteroids but not all patients have a favourable outcome. Other systemic agents have also been used such as cyclosporine, azathioprine, cyclophosphamide and tacrolimus. However, all these systemic therapies can be complicated by serious side effects. In this paper, we report a series of four patients with pyoderma gangrenosum treated successfully with topical cyclosporine. No side-effects were observed in any of the patients and there was minimal systemic absorption of the topical cyclosporine.

Matched MeSH terms: Pyoderma Gangrenosum/drug therapy*
Fulltext Dentine hypersensitivity-like tooth pain associated with the use of high-dose steroid therapy

Abdullah D, Syed Mohamed AMF, Cheen Liew AK

J Conserv Dent, 2019 3 2;22(1):102-106.
PMID: 30820092 DOI: 10.4103/JCD.JCD_113_18

Although corticosteroid provides many clinical benefits, it may cause a range of side effects. A 47-year-old female patient presented with a complaint of pain from her teeth, triggered upon taking cold, hot, and sweet food and drink. From her medical history, she was previously diagnosed with ulcerative colitis. She consequently developed pyoderma gangrenosum, and high-dose prednisolone was administered to treat this condition (prednisolone 30 mg bd for 4 months followed by tapering dose 5 mg/week). She claimed the pain started at the end of steroid therapy. The pain mimicked symptoms of dentine hypersensitivity, but without the presence of the clinical signs associated with hypersensitivity, suggesting that the pain was steroid induced. Patients in this condition will find that their dietary choices will be limited and effective oral hygiene be impeded. Reassurance and advising patients to maintain oral hygiene are the most appropriate treatment as this condition would eventually wear off with time.

Matched MeSH terms: Pyoderma Gangrenosum
Systemic fusarium infection in cancer patients : a report of two cases

Mohamed, M., Ariffin, H., Arasu, A., Tuck Soon, S.H., Abdullah, W.A., Lin, H.P.

Malaysian Journal of Paediatrics and Child Health, 1998;10(2):55-58.
MyJurnal

Fusarium species is an emerging genus of fungal pathogens which until recently were rare causes of human disease apart from localized infection of the skin and nails. Two cases of fungaemia due to Fusarium sp. in children are described. The first child, an 8-year old girl with acute myeloid leukaemia developed character-sitic pyoderma gangrenosum-like skin lesions before succumbing to disseminated Fusarium infection and acute respiratory distress syndrome. The second child, a 5-month old boy, developed pneumonia associated with a transient erythematous skin rash while on chemother-apy for congenital leukaemia. Both patients had Fusarium isolated from blood. The second child improved after six weeks of treatment with ampho-tericin B and granulocyte-macrophage colony stimulat-ing factor but ultimately she died of the disease follow-ing discharge. Fusarium spp should be recognised as an opportunistic pathogen in immunocompromised patients. Current literature suggests that liposomal amphotericin B in conjunction with leukocyte growth factors are the treatment of choice in this potentially fatal infection.

Matched MeSH terms: Pyoderma Gangrenosum
Fulltext Ulcerative colitis in Malaysians

Jayalakshmi P, Wong NW, Malik AK, Goh KL

JUMMEC, 1996;1(2):39-42.

A review of all colonic biopsies received by the Department of Pathology during a 8-year period revealed 41 cases of ulcerative colitis (UC). The diagnosis was based on histological and clinical features. The age range of patients was between 14 - 76 years with a median age of 35.4 years. The disease was more prevalent among Indians. The common presenting sysmptoms were diarrhoea (100%) and haematochezia (83%). The extent of colonic involvement varied. Twelve patients (29.2%) had pancolitis and 8 (19.5%) had proctitis.Extraintestinal manifestations were rare and only one patient had pyoderma gangrenosum. One patient developed multifocal colorectal cancer 10 years after the inial diagnosis of UC and died 2 years later due to metastases. Histology plays an important role in the diagnosis and management of patients with UC. We noted a good correlation between clinical and pathological features. The most recent colonic biopsy showed features of chronic UC with activity in 34 cases and features of remission in 4 cases.

Matched MeSH terms: Pyoderma Gangrenosum
Fulltext Pyoderma gangrenosum and cobalamin deficiency in systemic lupus erythematosus: a rare but non fortuitous association

Teoh SC, Sim CY, Chuah SL, Kok V, Teh CL

BMC Rheumatol, 2021 Mar 03;5(1):7.
PMID: 33653418 DOI: 10.1186/s41927-021-00177-4

BACKGROUND: Pyoderma gangrenosum (PG) is an uncommon, idiopathic, ulcerative neutrophilic dermatosis. In many cases, PG is associated with a wide variety of different disorders but SLE in association with PG is relatively uncommon. In this article we present the case of a middle aged patient with PG as the initial clinical presentation of SLE. We also provide a brief review of cobalamin deficiency which occurred in our patient and evidence-based management options.
CASE PRESENTATION: A 35 years old man presented with a 5 month history of debilitating painful lower limb and scrotal ulcers. This was associated with polyarthralgia and morning stiffness involving both hands. He also complained of swallowing difficulties. He had unintentional weight loss of 10 kg and fatigue. Physical examination revealed alopecia, multiple cervical lymphadenopathies, bilateral parotid gland enlargement and atrophic glossitis. There was Raynaud's phenomenon noted over both hands and generalised hyper-pigmented fragile skin. Laboratory results disclosed anaemia, leukopenia, hyponatraemia and hypocortisolism. Detailed anaemic workup revealed low serum ferritin and cobalamin level. The autoimmune screen showed positive ANA, anti SmD1, anti SS-A/Ro 52, anti SSA/Ro 60, anti U1-snRNP with low complement levels. Upper gastrointestinal endoscopy with biopsies confirmed atrophic gastritis and duodenitis. Intrinsic factor antibodies and anti-tissue transglutaminase IgA were all negative. Punch biopsies of the leg ulcer showed neutrophilic dermatosis consistent with pyoderma gangrenosum. Based on the clinical findings and positive immunologic studies, he was diagnosed as systemic lupus erythematosus. His general condition improved substantially with commencement of corticosteroids, immunosuppressants and vitamin supplements.
CONCLUSIONS: We report a case of PG as the first manifestation of SLE which was treated successfully with immunosuppressants and vitamin supplements. Our report highlighted the need to consider connective tissue diseases such as SLE in a patient presenting with PG in order for appropriate treatment to be instituted thereby achieving a good outcome.

Matched MeSH terms: Pyoderma Gangrenosum