The use of cultured epithelial autograft in a patient with idiopathic pyoderma gangrenosum

Pyoderma gangrenosum is an ulcerative cutaneous disorder that remains a diagnostic and therapeutic dilemma. Several medical therapies have been tried in treating the disorder. We report a patient with idiopathic pyoderma gangrenosum treated with the application of cultured epithelial autograft.

[Pyostomatitis vegetans. A specific marker of Crohn disease and ulcerative colitis]

Pyostomatitis vegetans is a rare disease of the oral cavity with characteristic clinical and histopathological findings. Its importance lies in its high correlation with inflammatory diseases of the intestinal tract. The present case report and a review of the literature are taken as a basis to discuss the disease as an entity. Pyostomatitis vegetans is a specific marker for ulcerative colitis and Crohn's disease.

Cutaneous vasculitis, hypersensitivity vasculitis, erythema nodosum, and pyoderma gangrenosum

Cutaneous vasculitis encompasses a highly heterogeneous group of disorders of diverse etiology, pathogenesis, and clinical features. Recent reexamination of clinical pathologic features have yielded no insights assisting our understanding of current clinical classification schemes and strengthening our clinical approach. Erythema nodosum is a common cutaneous disorder for which new etiologies continue to be described. Pyoderma gangrenosum is an uncommon ulcerative cutaneous condition that remains a therapeutic problem.

Pyoderma gangrenosum and malignant pyoderma in Nigeria

Five patients (four black Nigerian males and one Polynesian) with pyoderma gangrenosum (PG) were seen between May 1974 and March 1984, at the Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria. Their age range was 12-42 years (mean 25.6 years). The female expatriate Polynesian patient had PG localized to the upper back while the other four patients had severe and extensive PG lesions. Local cleansing and dressing of the ulcers combined with appropriate systemic antibiotics produced healing in two of these patients. The empirical addition of dapsone and rifampicin led to complete healing in two others, but only transient remission in one patient who, after 22 years of disease activity, died at home from an aggressive and accelerated form of the disease best described as 'malignant pyoderma' gangrenosum.

Wall-eyed bilateral internuclear ophthalmoplegia (Webino syndrome) and myelopathy in pyoderma gangrenosum

A 35-year-old female with pyoderma gangrenosum developed paraparesis with a sensory level at L1. Three months later she complained of diplopia and was found to have bilateral internuclear ophthalmoplegia with exotropia and no ocular convergence. The term Webino syndrome has been coined to design this set of neuro-ophthalmologic findings. Although it was initially attributed to lesions affecting the medial longitudinal fasciculus and the medial rectus subnuclei of the oculomotor complex in the midbrain the exact location of the lesion is still disputed. In the present case both myelopathy and Webino syndrome were probably due to vascular occlusive disease resulting from central nervous system vasculitis occurring in concomitance to pyoderma gangrenosum.

[Clinical analysis of 6 cases of pyoderma gangrenosum]

This article reports 6 cases of pyoderma gangrenosum of either acute or chronic clinical type. Etiologically, we found that minor local trauma could induce ulcerative and destructive lesions, with typical pyoderma gangrenosum features following in 4 cases. All the patients responded well to systemic corticosteroids. In comparison with cases reported in other countries, no systemic diseases (including ulcerative colitis, Crohn's disease and polyarthritis) were found in our series. Cultures taken from early pustular lesions were sterile. Histopathological examination showed heavy neutrophilic infiltration in the dermis, and no evidence of vasculitis was found in the biopsies. Immunological investigations revealed no specific reactions in our cases.

Pyoderma gangrenosum in childhood leukemia

A case of pyoderma gangrenosum (PG) in a 14-year-old boy with acute myelogenous leukemia (AML) is described. The onset of pyoderma gangrenosum coincided with the relapse of AML. The lesions responded dramatically to treatment with oral prednisone despite the persistence of leukemia. Pyoderma gangrenosum should be included in the differential diagnosis of any nodular, pustular, or necrotic cutaneous eruption in children with leukemia.

[Long-term follow-up of pyoderma gangrenosum (PG) associated with aortitis syndrome (AOS)]

It is known that PG is often associated with AOS. However, there have been no reports on long term follow-up of PG associated with AOS. We experienced a case of a 16 year old female who suffered from PG and AOS. The onset of both diseases occurred at the same time. On admission, many pustules and ulcers were found on the extremities. There was no finding of vasculitis in histopathological examinations. Development of skin lesions of PG coincided with the progress of AOS. But, AOS was progressive even when the patient was free of skin eruptions. It was concluded that the activity of PG was not always parallel to that of AOS.

[Smoldering leukemia with pyoderma gangrenosum]

A 76-year-old male admitted to Surugadai Nihon University hospital complaining of general fatigue, slight fever and anorexia. The laboratory examination revealed anemia and an appearance of a few myeloblasts and 7% of monocytes in the peripheral blood. The nucleated cell count was 2 x 10(4)/microliters with 43% myeloblasts in the bone marrow aspirate. He was diagnosed as acute myelomonocytic leukemia. He did not receive any chemotherapy for leukemia because of his old age and smoldering disease. Pyoderma gangrenosum developed in the left submandibular and axillary regions about 6 months later. Three more month later, significant increase of myeloblast was recognized in the peripheral blood and the bone marrow. It has been reported that pyoderma gangrenosum precedes a remarkable increase of leukemic cells in the patients with acute leukemia in complete remission and with myelodysplastic syndrome. In our case, to, the same process was strongly suggested.

Pyoderma gangrenosum complicating Felty's syndrome

The case of a 54-year-old woman with Felty's syndrome whose course was complicated by mucocutaneous lesions clinically typical of pyoderma gangrenosum is described. Necrotizing sinusitis and saddle nose deformity were distinctive clinical features. Lymphocytic vasculitis and rheumatoid nodule formation observed within panniculus at the base of a cutaneous lesion and in a nasal mucosal lesion were unexpected histopathologic findings.

Pyoderma gangrenosum in pediatric acquired immunodeficiency syndrome

We describe two children with human immunodeficiency virus infection in whom pyoderma gangrenosum developed. Although pyoderma gangrenosum most commonly occurs in children with inflammatory bowel disease, it has also been described in patients with a variety of immunodeficiencies. In such patients a vigorous search to exclude a treatable infection should be made before the lesions are treated as pyoderma gangrenosum.

A case of pyoderma vegetans associated with acne conglobata

A 41-year-old man visited our clinic because of vegetating plaques resembling pemphigus vegetans on his sacral and perianal areas. He had also suffered from acne conglobata since adolescence. A biopsy specimen taken from the perianal area showed marked acanthosis, exocytosis, and inflammatory infiltrates in the dermis, but no acantholysis. Direct and indirect immunofluorescent tests were negative for anti-intercellular antibodies. Bacterial cultures from the lesions showed many different types of organisms. We diagnosed the case as pyoderma vegetans and discussed the relationship between pyoderma vegetans and other pyoderma.

Inappropriate diagnosis of necrotizing arachnidism. Watch out Miss Muffet--but don't get paranoid

A 28-year-old man presented with painful progressive necrosis of the skin of his left leg which was associated with general toxicity and a high fever. A working diagnosis of necrotizing arachnidism was made, but no improvement followed two weeks of therapy with analgesics, antibiotics and antihistamines. His symptoms responded rapidly to prednisolone therapy, and a diagnosis of pyoderma gangrenosum was confirmed by biopsy. This subsequently proved to be associated with early acute myelomonocytic leukaemia.

Pyoderma gangrenosum complicating infection of the hand. A case report and review of the literature

Pyoderma gangrenosum is infrequently encountered by the orthopedic surgeon. The appearance of progressive, painful bullae followed injury and infection in a 56-year-old man. The treatment consisted of a search for an associated underlying systemic disease in concert with high-dose steroids. The etiology is not known.

Development of folliculitis and pyoderma gangrenosum in association with abdominal pain in a patient following treatment with isotretinoin

A 19-year-old man with severe acne developed extensive scalp folliculitis and later superficial pyoderma gangrenosum following treatment with isotretinoin. A cyclical neutropenia was noted and bone marrow findings suggested myelodysplasia. We believe that isotretinoin was implicated in the development of overt symptoms in this patient whose haematological condition was previously asymptomatic.

Squamous syringometaplasia in lobular panniculitis and pyoderma gangrenosum

Squamous metaplasia of eccrine sweat glands has been most frequently described in chronic cutaneous ulcerations with associated epidermal hyperplasia. We found examples of the process in skin biopsy specimens from five patients: three had associated lobular panniculitis and two had lesions of pyoderma gangrenosum. The metaplasia was located in the mid-to-deep reticular dermis in all five patients and extended into the superficial subcutis in one. Immunohistochemical stains for CEA and S-100 protein were used to accentuate the relationship of the metaplastic islands with eccrine ducts. It is postulated that necrosis of a portion of the eccrine duct is the stimulus for this process.

Pyoderma gangrenosum associated with erythroid hypoplasia

Pyoderma gangrenosum is most commonly associated with inflammatory bowel disease and rheumatoid arthritis, but it has been associated with various haematological malignancies. We describe its association with primary erythroid hypoplasia without thymoma in an 80 year old woman who presented with septicaemia complicating urinary tract infection. Spontaneous healing of an extensive lesion was observed.