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Borg Grech S, Vella Baldacchino A, Corso R, Pisani D, Boffa MJ. Superficial Granulomatous Pyoderma Successfully Treated with Intravenous Immunoglobulin. Eur J Case Rep Intern Med 2021; 8:002656. [PMID: 34671571 DOI: 10.12890/2021_002656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/05/2021] [Indexed: 11/05/2022] Open
Abstract
Superficial granulomatous pyoderma is a relatively rare variant of pyoderma gangrenosum, characterized by superficial ulceration with a vegetative margin and a clean granulating base. Ulcers in superficial granulomatous pyoderma are typically located on the trunk and may follow minor trauma. It may be misdiagnosed as classic pyoderma gangrenosum, despite having distinct characteristics. Here we report a case of superficial granulomatous pyoderma successfully treated with intravenous immunoglobulin (IVIg). LEARNING POINTS Superficial granulomatous pyoderma is a rare variant of pyoderma gangrenosum.Histopathological and clinical characteristics of superficial granulomatous pyoderma are distinct from those of classic pyoderma gangrenosum.Superficial granulomatous pyoderma is often slow-growing and is only rarely linked to underlying systemic disease.IVIg may be an effective treatment option for superficial granulomatous pyoderma.
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Affiliation(s)
| | | | - Roberto Corso
- Department of Dermatology, Mater Dei Hospital, Malta
| | - David Pisani
- Department of Histopathology, Mater Dei Hospital, Malta
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Milam EC, Brinster NK. Superficial granulomatous pyoderma of the leg improved after conservative management with Unna boot and intralesional steroid injections. JAAD Case Rep 2018; 4:797-799. [PMID: 30246130 PMCID: PMC6141699 DOI: 10.1016/j.jdcr.2018.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Emily C. Milam
- Correspondence to: Emily C. Milam, MD, New York University School of Medicine, 240 E 38th St, Fl 11, New York, NY 10016.
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3
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The role of infliximab in the treatment of superficial granulomatous pyoderma of the head and neck. J Am Acad Dermatol 2014; 71:e222-5. [DOI: 10.1016/j.jaad.2014.07.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/28/2014] [Accepted: 07/30/2014] [Indexed: 11/16/2022]
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D'Epiro S, Salvi M, Mattozzi C, Giancristoforo S, Faina V, Macaluso L, Luci C, Grieco T, Calvieri S, Richetta AG. Facial superficial granulomatous pyoderma. Int Wound J 2013; 12:737-8. [PMID: 24283375 DOI: 10.1111/iwj.12195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 11/04/2013] [Indexed: 02/02/2023] Open
Affiliation(s)
- Sara D'Epiro
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Monica Salvi
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Carlo Mattozzi
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Simona Giancristoforo
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Valentina Faina
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Laura Macaluso
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Cecilia Luci
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Teresa Grieco
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Stefano Calvieri
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Antonio G Richetta
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
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Ormaechea-Pérez N, López-Pestaña A, Lobo-Morán C, Tuneu-Valls A. Pioderma granulomatoso superficial. Presentación de 2 casos tratados con tacrolimus tópico. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.ad.2012.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ormaechea-Pérez N, López-Pestaña A, Lobo-Morán C, Tuneu-Valls A. Superficial Granulomatous Pyoderma. Report of 2 Cases Treated With Topical Tacrolimus. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:721-4. [DOI: 10.1016/j.adengl.2012.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 09/24/2012] [Indexed: 11/25/2022] Open
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Abstract
Metastatic Crohn disease is a rare cutaneous disorder characterized by noncaseating, granulomatous skin lesions present at sites anatomically separate from the gastrointestinal tract. It is the least common dermatologic manifestation of Crohn disease, and the differential diagnosis includes numerous similarly appearing, granulomatous skin entities. Males and females appear to be equally affected, and children tend to present with clinical lesions different from those of adults. An integration of clinical information, microscopic findings, and ancillary studies is necessary to accurately diagnose this rare cutaneous disease. Our objective is to review the clinical features, histopathologic characteristics, suggested pathogenesis, differential diagnosis, and current therapeutic options of metastatic Crohn disease.
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Affiliation(s)
- Alan Siroy
- Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA
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Tollefson MM, Cook-Norris RH, Theos A, Davis DMR. Superficial granulomatous pyoderma: a case in an 11-year-old girl and review of the literature. Pediatr Dermatol 2010; 27:496-9. [PMID: 21182640 DOI: 10.1111/j.1525-1470.2010.01271.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Superficial granulomatous pyoderma is a rare entity thought to be a variant of pyoderma gangrenosum and is often mistaken for classic pyoderma gangrenosum. Superficial granulomatous pyoderma has mainly been described in adults. We describe a case of Superficial granulomatous pyoderma in an 11-year-old girl and present a review of the literature. Superficial granulomatous pyoderma maintains clinical and histopathologic characteristics distinct from classic pyoderma gangrenosum and has a more favorable prognosis. It is often responsive to conservative treatment.
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Affiliation(s)
- Megha M Tollefson
- Division of Clinical Dermatology, Mayo Clinic, Rochester, MN 55905, USA
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Ratzinger G, Burgdorf W, Zelger BG, Zelger B. Acute febrile neutrophilic dermatosis: a histopathologic study of 31 cases with review of literature. Am J Dermatopathol 2007; 29:125-33. [PMID: 17414432 DOI: 10.1097/01.dad.0000249887.59810.76] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Sweet syndrome is a neutrophilic dermatosis defined by diagnostic criteria that include the lack of evidence for leukocytoclastic vasculitis. Because of the clinicopathological similarities on the one hand and the strict exclusion on the other hand, we were interested in a systematic evaluation of the relationship between these two diseases. We investigated the clinical and histopathological characteristics of 31 patients with Sweet syndrome, comparing our cases with 32 cases of leukocytoclastic vasculitis (including seven cases of urticarial vasculitis) and tried to place them in the background of published cases. There is a close relationship between Sweet syndrome and leukocytoclastic vasculitis in terms of clinical appearance, histopathological pattern, triggers, disease course, and response to treatment. The majority of the cases (23/31; 74%) showed histologic evidence of vasculitis, including nuclear dust, extravasation of erythrocytes, fibrin in and around vessel walls, and degeneration of collagen. Although one original criterion for Sweet syndrome is the absence of vasculitis, we propose that vasculitic changes should not exclude the diagnosis of Sweet syndrome. In contrast, Sweet syndrome can demonstrate vasculitis and may, similarly to urticarial vasculitis, be regarded a variant of leukocytoclastic vasculitis. Clinicopathologic characteristics with acute onset of juicy papules, plaques mostly on the face, shoulder, and trunk, and prominent edema probably reflect modifications of the pathogenetic process based on location and disease acuity.
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Affiliation(s)
- Gudrun Ratzinger
- Department of Dermatology and Venereology, Ludwig Maximilian University, Munich, Germany
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Bassi E, Matthews S, Cerio R. Superficial granulomatous pyoderma associated with chronic osteomyelitis. Br J Dermatol 2005; 153:684-6. [PMID: 16120175 DOI: 10.1111/j.1365-2133.2005.06822.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
INTRODUCTION Superficial granulomatous pyoderma is a rare variant of pyoderma gangrenosum, which is often diagnosed at a late stage because of misleading clinical-histopathological features. We report a new case of this rare disease. CASE REPORT A 67 year-old man presented with inflammatory lesions that had become ulcerated over the past 4 months despite prolonged antibiotic therapy. The histopathological aspect was initially suggestive of palisading granuloma annulare and subsequently a necrotizing granuloma compatible with a mycobacteriosis. The various supplementary examinations eliminated the possibility of an infectious or systemic disease. The lesions became painful and ulcerated. A second biopsy showed a neutrophilic dermatosis with dermal necrosis and a granuloma leading to the diagnosis of superficial granulomatous pyoderma. The lesions healed after 3 months of systemic corticosteroids at the dose of 1 mg/kg/day. DISCUSSION The clinical features of superficial granulomatous pyoderma are similar to those of classical pyoderma gangrenosum. However, its histological profile is more superficial and is associated with dermal granulomas. The latter are unusual in neutrophilic dermatosis and would suggest an infectious disease. This explains the frequent diagnostic errors, with inappropriate anti-infectious treatments and notably unnecessary surgical exeresis.
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Affiliation(s)
- M Mitcov Milea
- Clinique Dermatologique, Hôpitaux Universitaires, 1 place de l'Hôpital, 67091 Strasbourg, France
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Kaneko T, Tamai K, Yamazaki T, Harada K, Nakano H, Hanada K. Superficial granulomatous pyoderma: a case report of two Japanese patients and clinical comparison with foreign patients. J Dermatol 2003; 30:472-6. [PMID: 12810995 DOI: 10.1111/j.1346-8138.2003.tb00418.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2003] [Accepted: 03/18/2003] [Indexed: 11/30/2022]
Abstract
Superficial granulomatous pyoderma (SGP) is an unusual variant type of pyoderma gangrenosum characterized by a benign course and specific histological features; it is quite a rare cutaneous disorder in Japan. We reported two Japanese cases of SGP and compared the clinical features of 13 Japanese cases with those of 42 foreign cases. Case 1 was a 53-year-old female who presented with three indolent and ulcerative plaques with elevated edges on the back and the posterior portion of the left thigh. Case 2 was a 74-year-old female who presented with crusted and vegetative erythematous plaques on the left shoulder and left upper arm. Histological examinations revealed a characteristic three-layer granuloma in each case. Laboratory and physical examinations found no abnormalities. Topical corticosteroid, oral administration of minocycline, and/or additional supplementation with corticosteroid were effective. In comparison with foreign cases, Japanese cases show a possible differentiation in the ratio of sex and distribution of the ulcer. Females have a high incidence and the extremities are frequently involved area in Japanese cases. Up to now, 11 cases of SGP have been reported in Japan. To our best knowledge, our patients are the first Japanese cases described in the English literature.
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Affiliation(s)
- Takahide Kaneko
- Department of Dermatology, Hirosaki University School of Medicine, Hirosaki 036-8562, Japan
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13
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Abstract
Pyoderma gangrenosum is a noninfectious neutrophilic dermatosis that usually starts with sterile pustules which rapidly progress to painful ulcers of variable depth and size with undermined violaceous borders. In 17 to 74% of cases, pyoderma gangrenosum is associated with an underlying disease, most commonly inflammatory bowel disease, rheumatological or hematological disease or malignancy. Diagnosis of pyoderma gangrenosum is based on a history of an underlying disease, typical clinical presentation and histopathology, and exclusion of other diseases that would lead to a similar appearance. Randomized, double-blinded prospective multicenter trials investigating the treatment of pyoderma gangrenosum are not available. The treatments with the best clinical evidence are systemic corticosteroids (in the initial phase usually 100 to 200 mg/day) and cyclosporine (mainly as a maintenance treatment). Combinations of corticosteroids with cytotoxic drugs such as azathioprine, cyclophosphamide or chlorambucil are used in patients with disease that is resistant to corticosteroids. The combination of corticosteroids with sulfa drugs, such as dapsone, or clofazimine, minocycline and thalidomide, has been used as a corticosteroid-sparing alternative. Limited experience has been documented with methotrexate, colchicine, nicotine, and mycophenolate mofetil, among other drugs. Alternative treatments include local application of granulocyte-macrophage colony-stimulating factor, intravenous immunoglobulins and plasmapheresis. Skin transplants (split-skin grafts or autologous keratinocyte grafts) and the application of bioengineered skin is useful in selected cases in conjunction with immunosuppression. Topical therapy with modern wound dressings is useful to minimize pain and the high risk of secondary infection. The application of topical antibacterials cannot be recommended because of their potential to sensitize and their questionable efficacy, but systemic antibacterial therapy is mandatory when infection is present. Despite recent advances in therapy, the prognosis of pyoderma gangrenosum remains unpredictable.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology, Hospital Dresden-Friedrichstadt, PO Box 120906, 01008 Dresden, Germany.
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Affiliation(s)
- V J Swale
- Centre for Cutaneous Research, Barts and the London NHS Trust, London E1 2AT, UK
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15
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IDO T, WAKAHARA M, KIYOHARA T, ISHIGURO K, KUMAKIRI M, UEDA K, AOYAMA F. A Case of Superficial Granulomatous Pyoderma. ACTA ACUST UNITED AC 2001. [DOI: 10.2336/nishinihonhifu.63.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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16
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MURAYAMA N, ENDO M, ASAJIMA H, MATSUOKA Y, SAITO R, IWAHIRA Y. A Case of Superficial Granulomatous Pyoderma Associated with Anaphylactoid Purpura. ACTA ACUST UNITED AC 1995. [DOI: 10.2336/nishinihonhifu.57.230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
We report two cases of superficial granulomatous pyoderma (SGP). Unlike classical pyoderma gangrenosum this variant is characterized by a benign course, superficial ulceration and a granulomatous infiltrate. Although our cases share the typical features of SGP, they are noteworthy in that one had the disease for 18 years, and the other had concomitant sarcoidosis.
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Affiliation(s)
- N Hardwick
- Department of Dermatology, Royal Liverpool University Hospital, U.K
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Geller JD, Peters MS, Su WP. Cutaneous mucormycosis resembling superficial granulomatous pyoderma in an immunocompetent host. J Am Acad Dermatol 1993; 29:462-5. [PMID: 8349863 DOI: 10.1016/0190-9622(93)70211-b] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Primary cutaneous mucormycosis is uncommon and occurs mainly in immunosuppressed or diabetic patients or after localized trauma. We report a case of cutaneous mucormycosis in an immunocompetent man in whom no definite precipitating factors could be identified; initially, superficial granulomatous pyoderma was suspected clinically. The lesion was successfully treated with debridement, local wound care, parenteral administration of amphotericin B, and ultimately by surgical excision and split-thickness skin grafting.
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Affiliation(s)
- J D Geller
- Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905
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Inoue T, Mihara M, Nakayama H, Shimao S, Shimizu Y. Persistent facial ulcerations with a unique clinical appearance: possible trigeminal trophic syndrome. J Dermatol 1991; 18:171-4. [PMID: 1885851 DOI: 10.1111/j.1346-8138.1991.tb03061.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We reported a 53-year-old woman with a persistent facial ulcer which moved gradually from the right marginal portion of the nasal root to the right lateral canthus along the margin of the right lower eyelid. The ulcer healed spontaneously. A similar ulcer developed at the entrance of the right anterior naris. The clinical findings were suggestive of squamous cell carcinoma, deep mycosis, mycobacterial infection, or a related condition. However, no definitive diagnosis could be made from the clinicopathological findings or the laboratory examinations, including bacterial, mycobacterial, and fungal cultures. The characteristic location of the lesion, and course of the disease, however, suggested the diagnosis of trigeminal trophic syndrome.
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Affiliation(s)
- T Inoue
- Department of Dermatology, Faculty of Medicine, Tottori University, Yonago, Japan
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