Email this article Pyoderma gangrenosum of the hand: a missed diagnosis and lessons learned
- Authors: Maheshwari K.1, Yousif A.1, Burova E.1
-
Affiliations:
- Bedfordshire Hospitals NHS Foundation Trust
- Issue: Vol 23, No 4 (2020)
- Pages: 208-211
- Section: CLINICAL PICTURE, DIAGNOSIS, AND THERAPY OF DERMATOSES
- URL: https://rjsvd.com/1560-9588/article/view/48906
- DOI: https://doi.org/10.17816/dv48906
- ID: 48906
Cite item
Open Access
Access granted
Abstract
INTRODUCTION: Pyoderma gangrenosum (PG) is a challenging condition to diagnose and treat.
CASE REPORT: We discuss the case of a man who presented with a swollen and extremely tender finger, with bullous lesions, erythema, and a clinical picture suggestive of a necrotising fasciitis. He had a history of ulcerative colitis (UC) and had been taking azathioprine. Initial debridement of the affected tissues was carried out as an emergency, with no improvement. Pyoderma gangrenosum had been suspected at that stage and the patient was prescribed oral Prednisolone. He showed a remarkable recovery and his finger healed completely. Due to a persistent pancytopenia he underwent further tests and was subsequently diagnosed with Acute myeloid leukaemia (AML).
DISCUSSSION: Pyoderma gangrenosum is a diagnosis of exclusion. It can be a sign of internal malignancy and other medical conditions. Therefore, a low threshold must be kept for the diagnosis of this disorder, especially in patients with known risk factors.
CONCLUSION: Based on our experience, in similar clinical scenarios, we suggest limb elevation and antibiotics initially, with a close observation and consideration of the diagnosis of pyoderma gangrenosum prior to any surgical intervention. A thorough investigation of the possible reasons for PG is vitally important.
Keywords
Full Text
About the authors
K. Maheshwari
Bedfordshire Hospitals NHS Foundation Trust
Email: snarskaya-dok@mail.ru
United Kingdom, Bedfordshire
A. Yousif
Bedfordshire Hospitals NHS Foundation Trust
Email: snarskaya-dok@mail.ru
Russian Federation, Bedfordshire
E. Burova
Bedfordshire Hospitals NHS Foundation Trust
Author for correspondence.
Email: snarskaya-dok@mail.ru
Consultant Dermatologist
United Kingdom, BedfordshireReferences
- Alonso-Leon T, Hernandez-Ramirez HH, Fonte-Avalos V, Toussaint-Caire S, Vega-Memije ME, Lozano-Platonoff A. The great imitator with no diagnostic test: pyoderma gangrenosum. Int Wound J. 2020. doi: 10.1111/iwj.13466. [online ahead of print, 2020 Aug 11].
- Leitsch S, Koban KC, Pototschnig A, Titze V, Giunta RE. Multimodal therapy of ulcers on the dorsum of the hand with exposed tendons caused by pyoderma gangrenosum. Wounds. 2016;28(3):E10-3.
- Lancerotto L, Tocco I, Salmaso R, Vindigni V, Bassetto F. Necrotizing fasciitis: classification, diagnosis, and management. J Trauma Acute Care Surg. 2012;72(3):560-6.
- Tay DZ, Tan KW, Tay YK. Pyoderma gangrenosum: a commonly overlooked ulcerative condition. J Family Med Prim Care. 2014;3(4):374-8.
- Sasor SE, Soleimani T, Chu MW, Cook JA, Nicksic PJ, Tholpady SS. Pyoderma gangrenosum demographics, treatments, and outcomes: an analysis of 2,273 cases. J Wound Care. 2018;27(Suppl.1):S4-8.
- Vacas AS, Torre AC, Bollea-Garlatti ML, Warley F, Galimberti RL. Pyoderma gangrenosum: clinical characteristics, associated diseases, and responses to treatment in a retrospective cohort study of 31 patients. Int J Dermatol. 2017;56(4):386-91. doi: 10.1111/ijd.13591.
- George C, Deroide F, Rustin M. Pyoderma gangrenosum – a guide to diagnosis and management. Clin Med (Lond). 2019;19(3):224-8.
- Langan SM, Groves RW, Card TR, Gulliford MC. Incidence, mortality, and disease associations of pyoderma gangrenosum in the United Kingdom: a retrospective cohort study. J Invest Dermatol. 2012;132(9):2166-70. doi: 10.1038/jid.2012.130
- Braun-Falco M, Kovnerystyy O, Lohse P, Ruzicka T. Pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH) – a new autoinflammatory syndrome distinct from PAPA syndrome. J Am Acad Dermatol. 2012;66(3):409-15. doi: 10.1016/j.jaad.2010.12.025.
- Cohen PR. Neutrophilic dermatoses: a review of current treatment options. Am J Clin Dermatol. 2009;10(5):301-12.
- Miller J, Yentzer BA, Clark A, Jorizzo JL, Feldman SR. Pyoderma gangrenosum: a review and update on new therapies. J Am Acad Dermatol. 2010;62(4):646-54. doi: 10.1016/j.jaad.2009.05.030.
- Reichrath J, Bens G, Bonowitz A, Tilgen W. Treatment recommendations for pyoderma gangrenosum: an evidence-based review of the literature based on more than 350 patients. J Am Acad Dermatol. 2005;53(2):273-83. doi: 10.1016/j.jaad.2004.10.006.
- Brooklyn TN, Dunnill MGS, Shetty A, Bowden JJ, Williams JDL, Griffiths CEM, et al. Infliximab for the treatment of pyoderma gangrenosum: a randomised, double blind, placebo controlled trial. Gut. 2006;55(4):505-9. doi: 10.1136/gut.2005.074815.
Supplementary files
