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Skin and soft tissue
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Classic pyoderma gangrenosum may be associated with symptoms of pain, fever, malaise, myalgia and arthralgia. The aetiology is unclear but seems to be related to altered immunological reactivity. Approximately 50% of cases are associated with a specific systemic disorder: inflammatory bowel disease, rheumatoid arthritis, non-Hodgkin’s lymphoma, Wegener’s granulomatosis (especially head and neck lesions) and myeloproliferative disorders. The other 50% have no identifiable risk factors.
Dermatology
Published in Fazal-I-Akbar Danish, Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Diseases associated with pyoderma gangrenosum:1 Idiopathic (50%).2 GI: IBD.3 Liver: chronic active hepatitis; PBC; sclerosing cholangitis.4 Joints: RA; seronegative arthropathies.5 Vasculitides (Wegener’s granulomatosis).6 Malignancy: myeloma (paraproteinaemia); ca. colon, prostate, breast; leukaemia/lymphoma.7 Endocrine diseases: DM; thyroid disease.8 At sites of trauma (Koebner’s phenomenon).
Inflammatory dermatoses affecting the nail
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
Pyoderma gangrenosum can only be diagnosed when there is no leukocytoclastic vasculitis and an infection has reliably been ruled out.287,300 In early lesions, Sweet's syndrome may histologically be identical, but it does not exhibit collagen lysis and vessel wall necrosis in areas of dense neutrophilic infiltrates. Pyoderma gangrenosum may be vegetating and even resemble pemphigus vegetans.301,302 Pustular vasculitis of the hands limited to the dorsal aspect of the fingers and hands303 has now been reclassified as neutrophilic dermatosis of the dorsal hands as it does not show true vasculitis with direct vessel wall damage.304
Pyoderma gangrenosum with pulmonary involvement: a pulmonary special report and literature review
Published in Expert Review of Respiratory Medicine, 2022
Fanfan Xing, Kelvin Hei-Yeung Chiu, Jin Yang, Haiyan Ye, Lijun Zhang, Chenjing Liu, Kwok-Yung Yuen
Pyoderma gangrenosum with pulmonary involvement is an unusual presentation of a rare disease. The nonspecific nature of initial presenting symptoms, radiological findings together with requirement of invasive procedures such as bronchoscopy and lung biopsy are the challenges of making the correct diagnosis. It is paramount for clinicians to be aware of the possibility of pulmonary involvement of pyoderma gangrenosum in younger population, as a delay in diagnosis without prompt treatment may result in life-threatening consequences. We believe that early involvement of dermatologists in patients presented with pyoderma gangrenosum-like lesions may shorten the time from clinical presentation to arriving at the correct diagnosis. In order to guide non-dermatologists in diagnosing PG, useful and novel diagnostic algorithms should be designed and introduced in order to strengthen the awareness of clinicians on this clinical entity. Although currently such diagnostic algorithms are not yet available, scoring system approach based on underlying disease, age and extend of rash involvement may be helpful for clinicians in evaluation of the likelihood of the pulmonary involvement is due to pyoderma gangrenosum or not. Furthermore, PG with pulmonary involvement is still an entity that requires further investigation and study, as its relationship with other demographic factors such as ethnicity is not yet well understood.
Atypical Pyoderma gangrenosum: a case of delayed recognition
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Anum Qureshi, Kia Persaud, Sajida Zulfiqar, Ranadheer Dande, Chahat Puri, Shankar Awasthi
Pyoderma gangrenosum (PG) is a rare inflammatory skin condition with an annual incidence of 3–10 cases in one million people. The pathogenesis is unclear but involves aberrant neutrophil activity [1] as well as a genetic component [2]. Underlying systemic disease is present in 50–70% of cases [3], and includes hematological disorders, inflammatory bowel disease (IBD) and rheumatoid arthritis. It can manifest initially as a papule, pustule, or vesicle that progresses to a painful ulcer [4]. PG is often misdiagnosed as a skin and soft tissue infection and inappropriately treated with antibiotics with no benefit. This may prompt intervention with surgical debridement, which frequently leads to a vicious cycle of worsening necrosis given the strong association of PG with severe pathergy phenomenon. Significant morbidity can be prevented by early diagnosis and treatment [5]. PG of the breast is rare, with only 43 reported cases, 70% of which developed after breast surgery [6]. The most frequently involved areas are the lower extremities including the pretibial area. The trunk, head and neck, and peristomal skin are less frequently affected.
Pyoderma gangrenosum in primary care setting: the challenges involved
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
‘Pyoderma Gangrenosum’ (PG) originated as a term in 1930 when incorrectly described as a purulent ‘streptococcal’ skin infection (‘Pyoderma’) leading to necrosis of tissue (‘Gangrenosum’) [1]. This description was later disapproved as it is proven to be a noninfectious condition. However, the use of the misnomer ‘Pyoderma Gangrenosum’ has persisted in medical literature due to its classical manifestation as single or multiple painful ulcers usually seen on the lower extremities. In its real essence, PG is a chronic inflammatory form of neutrophilic dermatosis characterized by accumulation of neutrophils in the skin with rare involvement of the internal organs. It is estimated to occur in every 3–10 individuals/million and is usually seen in middle age with women being more affected. Childhood PG can be seen in up to 4% of total cases [2].