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Yamamoto T. Local neutrophil and eosinophil extracellular traps formation in pyodermatitis pyostomatitis vegetans. Exp Dermatol 2024; 33:e14931. [PMID: 37694984 DOI: 10.1111/exd.14931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Abstract
Pyodermatitis pyostomatitis vegetans is a rare inflammatory condition, affecting the skin and/or mucous membrane. Some cases include both skin and mucous involvement, whereas others develop either skin or mucous lesions only. The typically affected areas are the scalp, face, trunk and extremities, including the flexural areas and umbilicus. Clinical features show erosive granulomatous plaques, keratotic plaques with overlying crusts and pustular lesions. Among mucous lesions, oral mucosa is most frequently involved, and gingival erythema, shallow erosions, cobblestone-like papules on the buccal mucosa or upper hard palate of the oral cavity are also observed. Some of the lesions assume a 'snail track' appearance. Although there are several similarities between pyodermatitis pyostomatitis vegetans and other diseases, that is pyoderma gangrenosum, pemphigus vegetans and pemphigoid vegetans, the histopathological features of pyodermatitis pyostomatitis vegetans are unique in that epidermal hyperplasia, focal acantholysis and dense inflammatory infiltrates with intraepidermal and subepidermal eosinophilic microabscesses are observed. Direct immunofluorescence findings are principally negative. Activated neutrophils are supposed to play an important role in the pathogenesis of pyodermatitis pyostomatitis vegetans. The expression of IL-36 and neutrophil extracellular traps (NETs) was observed in the lesional skin, and additionally, eosinophil extracellular traps (EETs) was detected in pyodermatitis pyostomatitis vegetans. A possible pathogenic role of NETs and EETs in the innate immunity and autoinflammatory aspects of pyodermatitis pyostomatitis vegetans was discussed.
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Affiliation(s)
- Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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Katz TM, Katz AM. Idiopathic pyostomatitis-pyodermatitis vegetans with nasal obstruction: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231160909. [PMID: 36950050 PMCID: PMC10026124 DOI: 10.1177/2050313x231160909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2023] Open
Abstract
Pyostomatitis-pyodermatitis vegetans is an uncommon mucocutaneous dermatosis of unknown etiology. It presents as erythematous pustules that coalesce to form exudative vegetating plaques on the oral mucosa and/or skin. Diagnosis is largely based on clinical assessment, although histopathology should be used as supporting evidence. Pyostomatitis-pyodermatitis vegetans is associated with inflammatory bowel disease, liver dysfunction, and others. We report a case of a 48-year-old man who presented with erythematous eroded plaques involving his nares and upper lip. Investigations revealed a dense mixed inflammatory infiltrate and pronounced peripheral eosinophilia. Uniquely, the patient did not have inflammatory bowel disease or any other systemic condition. Systemic corticosteroids were helpful in clearing mucocutaneous lesions; however, this effect was only sustained at high doses. There are few reports of pyostomatitis-pyodermatitis vegetans in the medical literature. This case highlights key aspects of this extremely rare dermatosis, especially in otherwise healthy patients without inflammatory bowel disease.
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Affiliation(s)
- Talia M Katz
- Faculty of Health Sciences, Queen’s
University, Kingston, ON, Canada
| | - Arnon M Katz
- Private Dermatology Practice,
Newmarket, ON, Canada
- Arnon M Katz, Private Dermatology Practice,
531 Davis Drive (Suite 304), Newmarket, ON L3Y 6P5, Canada.
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3
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Reddy SB, Wang S, Graham LV. Successful treatment of pyoderma vegetans with doxycycline. JAAD Case Rep 2022; 21:10-13. [PMID: 35141379 PMCID: PMC8814734 DOI: 10.1016/j.jdcr.2021.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Zhao X, Jiang S, Chen Y, Liu J, Liu J, Shi X. Sweet's syndrome and mucosal prolapse polyps in a male patient with ulcerative colitis. BMC Gastroenterol 2021; 21:478. [PMID: 34915857 PMCID: PMC8680040 DOI: 10.1186/s12876-021-02052-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sweet's syndrome (SS), also known as acute febrile neutrophilic dermatosis, is a rare neutrophilic dermatitis characterized by pyrexia, neutrophilia and painful papulonodular lesions with a neutrophilic dermal infiltrate. CASE PRESENTATION We presented a case report of classical SS associated with ulcerative colitis (UC) and mucosal prolapse polyps (MPPs) in a male patient. CONCLUSIONS The particularity of this case is the occurrence of MPPs in a male patient with UC and classical SS. We also discussed whether this patient with concurrent Epstein-Barr virus infection could be treated with corticosteroids.
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Affiliation(s)
- Xixian Zhao
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China.,Hubei Clinical Center and Key Lab of Intestinal and Colorectal Diseases, Wuhan, 430071, China
| | - Si Jiang
- Department of Dermatology and Venereology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yanan Chen
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China.,Hubei Clinical Center and Key Lab of Intestinal and Colorectal Diseases, Wuhan, 430071, China
| | - Jialong Liu
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China.,Hubei Clinical Center and Key Lab of Intestinal and Colorectal Diseases, Wuhan, 430071, China
| | - Jing Liu
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China. .,Hubei Clinical Center and Key Lab of Intestinal and Colorectal Diseases, Wuhan, 430071, China.
| | - Xianyan Shi
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China. .,Hubei Clinical Center and Key Lab of Intestinal and Colorectal Diseases, Wuhan, 430071, China.
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Alvarez-Payares JC, Ramírez-Urrea S, Correa-Parra L, Salazar-Uribe D, Velásquez-López M. Mucocutaneous Manifestations of Inflammatory Bowel Disease. Cureus 2021; 13:e17191. [PMID: 34548985 PMCID: PMC8439267 DOI: 10.7759/cureus.17191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/05/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic and incurable disease, of unknown etiology, associated with an unregulated immune response to environmental triggers in a genetically predisposed host. IBD affects mainly the gastrointestinal (GI) tract and includes Crohn's disease (CD) and ulcerative colitis (UC). However, a large percentage of patients may present with extraintestinal manifestations, including mucocutaneous ones (which are the most common) and dermatologic findings, such as erythema nodosum, pyoderma gangrenosum, and aphthous stomatitis (which are the most frequently occurring). According to pathophysiologic mechanisms, mucocutaneous manifestations of IBD are classified into five categories, namely, specific manifestations, associated manifestations, reactive manifestations, adverse effects of IBD therapy, and malabsorption manifestations. Recognizing such manifestations should not be performed only by a dermatologist but also other specialties such as internal medicine, gastroenterology, among others. This is because these manifestations can present before the IBD diagnosis, even in the absence of GI symptoms. Therefore, these skin lesions could be a fundamental tool for the earlier diagnosis of IBD. This review provides a comprehensive overview of the most common cutaneous manifestations of IBD with a focus on their epidemiology, diagnostic criteria, clinical presentation, and available medical treatment.
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Stagg B, Simpson A, Sidhu S. Similar but different: distinguishing between pemphigus vegetans and pyostomatitis-pyodermatitis vegetans. BMJ Case Rep 2021; 14:14/4/e242162. [PMID: 33879466 PMCID: PMC8061807 DOI: 10.1136/bcr-2021-242162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 51-year-old woman presented with a 4-month history of painful ulcers in the mouth and vulva, and painful vegetative plaques at intertriginous sites. Skin biopsies showed squamous hyperplasia and intraepidermal eosinophilic pustulation. Skin direct immunofluorescence (DIF) revealed intercellular deposition of IgG and C3 in the lower part of the epidermis, while serum indirect immunofluorescence (IIF) confirmed the presence of antiepithelial antibodies. The patient was diagnosed with pemphigus vegetans, and successfully treated with dapsone, prednisolone and topical steroids. Although pemphigus vegetans and pyostomatitis-pyodermatitis vegetans can show identical clinical and histological features, the presence or absence of comorbid inflammatory bowel disease, and the results of both skin DIF and serum IIF can be used to distinguish between these two conditions. This case report explores the challenges in making this distinction, and the implications of establishing the correct diagnosis.
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Affiliation(s)
| | - Anna Simpson
- Clinpath Pathology, Mile End, South Australia, Australia
| | - Shireen Sidhu
- North Eastern Health Specialists, Hectorville, South Australia, Australia
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Antonelli E, Bassotti G, Tramontana M, Hansel K, Stingeni L, Ardizzone S, Genovese G, Marzano AV, Maconi G. Dermatological Manifestations in Inflammatory Bowel Diseases. J Clin Med 2021; 10:jcm10020364. [PMID: 33477990 PMCID: PMC7835974 DOI: 10.3390/jcm10020364] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel diseases (IBDs) may be associated with extra-intestinal manifestations. Among these, mucocutaneous manifestations are relatively frequent, often difficult to diagnose and treat, and may complicate the course of the underlying disease. In the present review, a summary of the most relevant literature on the dermatologic manifestations occurring in patients with inflammatory bowel diseases has been reviewed. The following dermatological manifestations associated with IBDs have been identified: (i) specific manifestations with the same histological features of the underlying IBD (occurring only in Crohn's disease); (ii) cutaneous disorders associated with IBDs (such as aphthous stomatitis, erythema nodosum, psoriasis, epidermolysis bullosa acquisita); (iii) reactive mucocutaneous manifestations of IBDs (such as pyoderma gangrenosum, Sweet's syndrome, bowel-associated dermatosis-arthritis syndrome, aseptic abscess ulcers, pyodermatitis-pyostomatitis vegetans, etc.); (iv) mucocutaneous conditions secondary to treatment (including injection site reactions, infusion reactions, paradoxical reactions, eczematous and psoriasis-like reactions, cutaneous infections, and cutaneous malignancies); (v) manifestations due to nutritional malabsorption (such as stomatitis, glossitis, angular cheilitis, pellagra, scurvy, purpura, acrodermatitis enteropathica, phrynoderma, seborrheic-type dermatitis, hair and nail abnormalities). An accurate dermatological examination is essential in all IBD patients, especially in candidates to biologic therapies, in whom drug-induced cutaneous reactions may assume marked clinical relevance.
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Affiliation(s)
| | - Gabrio Bassotti
- Gastroenterology Section, Perugia General Hospital, 06156 Perugia, Italy;
- Gastroenterology & Hepatology Section, Department of Medicine, University of Perugia, 06156 Perugia, Italy
- Correspondence:
| | - Marta Tramontana
- Dermatology Section, Department of Medicine, University of Perugia, 06156 Perugia, Italy; (M.T.); (K.H.); (L.S.)
| | - Katharina Hansel
- Dermatology Section, Department of Medicine, University of Perugia, 06156 Perugia, Italy; (M.T.); (K.H.); (L.S.)
| | - Luca Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, 06156 Perugia, Italy; (M.T.); (K.H.); (L.S.)
| | - Sandro Ardizzone
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, “L.Sacco” Hospital, 20157 Milano, Italy; (S.A.); (G.M.)
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCSS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (G.G.); (A.V.M.)
- Department of Pathophysiology and Transplantation, University of Milano, 20122 Milano, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCSS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (G.G.); (A.V.M.)
- Department of Pathophysiology and Transplantation, University of Milano, 20122 Milano, Italy
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, “L.Sacco” Hospital, 20157 Milano, Italy; (S.A.); (G.M.)
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Alfurayh N, Alhumidi A, Alkeraye S. Pyodermatitis vegetans responding to rifampicin and clindamycin. JAAD Case Rep 2019; 5:1078-1080. [PMID: 31799357 PMCID: PMC6881624 DOI: 10.1016/j.jdcr.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nuha Alfurayh
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Alhumidi
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salim Alkeraye
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Rodríguez-Lomba E, Molina-López I, Vilas-Boas PT, Suárez-Fernández R. IgA deposition in a vegetating plaque on the glans penis: a diagnostic dilemma. Int J Dermatol 2018; 58:e64-e66. [PMID: 30478828 DOI: 10.1111/ijd.14318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Irene Molina-López
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pedro Tiago Vilas-Boas
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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