Pyoderma gangrenosum in a patient with chronic myeloid leukemia

We report a case of pyoderma gangrenosum in association with chronic myeloid leukemia. The clinical and pathological features are reviewed and the relationship with hematological disorders is discussed.

[Gangrenous pyoderma. A review]

Pyoderma gangrenosum is a distinctive, uncommon, ulcerative condition with an associated systemic disease in most cases. The causative mechanism of this disease is still unknown. In this article, we review the pathogenesis of pyoderma gangrenosum, its clinicopathologic picture and the currently available therapeutic alternatives. Associations with systemic disease are also reviewed.

Pyoderma gangrenosum in an allogeneic bone marrow transplant recipient

We present the case of a 15-year-old boy who developed facial pyoderma gangrenosum following an allogeneic bone marrow transplantation for the treatment of a 'blast' crisis developing in the course of chronic myelogenous leukaemia. The lesion appeared 7 months before any evidence of relapse. The discussion is focused on both the presentation of pyoderma gangrenosum associated with myelo-proliferative disorders and its pathogenesis via the underlying immunosuppression.

Pyoderma gangrenosum and related disorders

Pyoderma gangrenosum (PG) is an uncommon ulcerative cutaneous condition with distinctive clinical characteristics and a frequent association with systemic diseases. Most frequently among the associated disease list are: inflammatory bowel disease, arthritis, and a variety of hematologic disorders. There is no specific treatment of PG; however, the effective treatment of an accompanying systemic disease, local therapy, and/or the use of topical or systemic agents known to be useful in neutrophil disorders, have been beneficial in most patients.

Pyoderma gangrenosum with pulmonary involvement

A 60-year-old woman had a typical pyoderma gangrenosum with monoclonal IgA gammopathy and atrophic gastritis. Two years after the onset of her skin disease, she had evidence of pulmonary abscesslike involvement. Corticosteroid therapy led to healing of skin and lung diseases. This case stresses the multisystemic manifestations of neutrophilic dermatoses with special attention to pulmonary involvement.

Chlorambucil--an effective corticosteroid-sparing therapy for pyoderma gangrenosum

A 21-year-old man, with a past history of severe aphthosis and arthritis between age 5 and 15 years, presented at age 18 years with a large leg ulceration, which developed after minor trauma. At that time he was otherwise healthy and taking no medications. Between 1983 and 1986 the patient failed to respond to intensive topical care to the ulcer, two attempted skin grafts, oral prednisone (up to 200 mg/day), sulfasalazine, dapsone (200 mg/day), multiple trials of intralesional triamcinolone acetonide, hyperbaric oxygen, azathioprine, methotrexate, clofazimine, minocycline, and three courses of pulse methylprednisolone therapy. Therapy with chlorambucil (4 mg/day) resulted in progressive improvement and complete healing with eventual cessation of all other therapy. The use of chlorambucil in pyoderma gangrenosum may be an effective adjunctive steroid-sparing therapy.

[Pustular arthro-osteitis associated with gangrenous pyoderma. Apropos of 1 case and a review of the literature]

Pustulotic arthro-osteitis is a rare syndrome manifested by palmo-plantar pustulosis and abnormalities involving the anterior chest wall, the spine, the sacroiliac and peripheral joints. We present the case of a patient with pustulotic arthro-osteitis who developed pyoderma gangrenosum. We believe this association has not been previously described in the literature.

Histopathologic features of superficial granulomatous pyoderma

Study of the histopathologic pattern of 28 cases of superficial granulomatous pyoderma demonstrated an ulcerative, verrucous pyoderma of the superficial dermis. Focal abscesses in the subepidermis or dermis were juxtaposed with granuloma formation and plasma cell inflammation. Hemorrhage and granulation tissue were present. The clinical lesions are indolent, and this feature is confirmed by chronic inflammatory elements, including sinus tract formation and focal fibrosis. Superficial granulomatous pyoderma must be added to the histologic differential diagnosis of the vegetative and ulcerative granulomas: blastomycosis, tuberculosis verrucosa cutis, and bromoderma.

Superficial granulomatous pyoderma: clinicopathologic spectrum

Superficial granulomatous pyoderma is a form of pyoderma gangrenosum characterized by superficial ulceration and a chronic course. Histopathologic examination shows a granulomatous response. We report two new cases of superficial granulomatous pyoderma in detail and briefly review the clinical data of five previous cases included in a recent series. These lesions typically begin as single furunculoid papules that most commonly occur on the trunk and that may arise at sites of surgical treatment or other pathergic stimuli. The lesions progress to superficial ulcers with a relatively clean base and vegetative borders. Tetracycline, minocycline, sulfapyridine, dapsone, and intralesionally administered corticosteroids have been effective anti-inflammatory agents, producing healing and allowing avoidance of the use of systemic corticosteroids in the management of most patients with superficial granulomatous pyoderma.

Neutrophilic vascular reactions

Dermatologic diseases are classified most commonly by morphology, by pathogenesis, or by etiology. Nontraditional classifications may be useful in terms of providing a reassessment of traditional views about disease interrelationships. This review of dermatoses characterized by neutrophilic infiltrates and dermal vessel changes reveals evidence suggesting that these dermatoses result from immune complex-mediated, neutrophil-induced dermal vessel damage. Therapeutic approaches to these heretofore unlinked dermatoses are remarkably similar.

Pyoderma gangrenosum or cutaneous lymphoma: a difficult clinical diagnosis

Pyoderma gangrenosum is frequently associated with an underlying condition such as ulcerative colitis or a myeloproliferative syndrome. However, lymphoproliferative malignancies have only rarely been seen concurrently with pyoderma gangrenosum. We present the case of a patient with small lymphocytic lymphoma who noted a slowly enlarging skin ulcer that was clinically consistent with pyoderma gangrenosum. Examination of a biopsy specimen showed infiltration of the skin with lymphoma cells as well as deeper necrotic material and thrombosis of vessels that were infiltrated by lymphoma. This case illustrates the difficulty of differentiating pyoderma gangrenosum from cutaneous lymphoma clinically.

A case of malignant pyoderma with neurological manifestations

A case of malignant pyoderma with a fatal course is presented. A 62-year-old Chinese man was admitted with a 8-month history of progressive ulcerative nodular skin lesions starting on the right antecubital fossa and spreading to the chest, face, arms and legs. The lesions failed to respond to many antibiotics. Examination revealed multiple large crusted foul-smelling ulcers with erythematous raised vegetative edges and tender erythematous nodules. Investigations showed an anaemia of chronic disease and an erythrocyte sedimentation rate of 135mm/1st hour. Histology showed multiple circumscribed microabscesses in the upper dermis. The skin lesions responded well to systemic corticosteroid therapy. Three months after admission, he developed multiple cranial nerve palsies, and severe progressive peripheral neuropathy. Radiographic studies revealed cavitating lesion in the right upper lobe consistent with a diagnosis of carcinoma of the lung. Five months after admission, patient was intubated for stridor but he succumbed to aspiration pneumonia. Malignant pyoderma should be considered if an ulcer fails to respond to antibiotics, and possible neurological complications should be thought of.

Pyoderma gangrenosum involving the head and neck

Pyoderma gangrenosum (PG) is a rare pathergy associated with systemic diseases such as ulcerative colitis and polycythemia vera. Its recognition in the differential diagnosis of other ulcerative lesions is important in managing an affected patient. A patient who developed lower extremity, oral, and cervical manifestations of this disease on separate occasions is presented. It is imperative that every clinician be aware of this entity because of the potential untoward effects of delayed or improper treatment including unnecessary surgery. Systemic and intralesional steroids are the treatment of choice.

Cyclosporine therapy for pyoderma gangrenosum associated with sclerosing cholangitis and ulcerative colitis

Malignant pyoderma of the right ear developed in a 58-year-old woman, and it spread insidiously over the entire right side of the face. Pyoderma gangrenosum was diagnosed on the basis of clinical and histologic findings and the patient's history of ulcerative colitis and sclerosing cholangitis. After successive therapeutic failures with a score of conventional approaches over an 18-month period, oral cyclosporine, 10 mg/kg/day, was started. Significant healing of the skin was noted within 1 month. There was an associated remission of the patient's cholangitis and inflammatory bowel disease. The dosage of cyclosporine was progressively tapered and then discontinued after 7 months, when healing was complete. No relapse occurred in the subsequent 14 months, and there was an associated remission of the patient's cholangitis and inflammatory bowel disease. Cyclosporine merits serious attention for treatment of both pyoderma gangrenosum and sclerosing cholangitis.

[Pyoderma gangraenosum as an orthopedic problem case]

A problematic case of pyoderma gangraenosum in a patient with colitis ulcerosa mimicing an empyema of the knee joint is reported.

Superficial granulomatous pyoderma: a localized vegetative form of pyoderma gangrenosum

Twenty-five patients had superficial ulcerative and vegetative pyoderma with granulomatous histologic findings. Healing occurred without systemic corticosteroid therapy in all but three patients. All patients had clinical pyoderma gangrenosum. In five patients the lesion occurred after surgery of the skin. Histopathologic study of 40 biopsy specimens showed focal neutrophilic abscesses of the papillary dermis, often with peripheral palisading histiocytes and foreign-body giant cells. Pseudoepitheliomatous, vegetative hyperplasia and sinus tract formation were observed frequently. All patient had massive areas of plasmacytosis, and 13 had eosinophils. Granulation tissue, hemorrhage, and fibrosis were additional features in some areas. Foreign material in the lesions was considered unimportant, except in one patient with a starch granuloma. Therapy with local corticosteroids, minocycline, tetracycline, or sulfa drugs resulted in healing in 15 patients. We believe that we have identified a localized, limited form of chronic superficial pyoderma gangrenosum with verrucous and ulcerative lesions and a granulomatous histologic appearance that represents a unique pattern of this disease in some patients.

Pustular ulcerative dermatosis of the scalp

Six young African patients are described with erosive pustular scalp lesions leading to extensive ulceration. No bacterial or fungal cause was found. Biopsies showed non-specific changes of atrophy with subacute or chronic inflammation. Four patients were malnourished and anaemic and three were infested with hookworm. The condition did not respond to antibiotics. Healing was obtained in one patient with systemic steroids. The relationship of this disorder to erosive pustular dermatosis of the scalp and to pyoderma gangrenosum of atypical distribution is discussed.