1
|
Zhang XQ, Tang ZW, Jing J. Progressive Facial Ulcer: A Case Report of Pyoderma gangrenosum. J Inflamm Res 2024; 17:687-691. [PMID: 38332897 PMCID: PMC10849904 DOI: 10.2147/jir.s441751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by rapidly developing and painful skin ulcers with distinctive features. As far as we are concerned, there is no previous case report on facial PG in East-Asia. In this case, we describe a case of a 79-year-old man with a 3-month history of progressive painful ulcers on his cheek and upper lip. Initial suspicion of atypical mycobacterium infection led to an ineffective treatment regimen. Comprehensive infectious testing yielded negative results, and a positive pathergy test indicated a potential diagnosis of PG. A skin biopsy confirmed the diagnosis, and the patient showed significant improvement with intravenous methylprednisolone and oral cyclosporine treatment. After three months, complete resolution of the lesions was achieved without recurrence. The case highlights the diagnostic challenges associated with PG, which is often misdiagnosed due to its resemblance to other conditions. Thorough evaluation is crucial to exclude alternative diagnoses, particularly cutaneous infections. Clinical morphology, tissue biopsy, and culture are essential for accurate diagnosis. The presence of pathergy, the development of new lesions following minor trauma, can also be a diagnostic clue.
Collapse
Affiliation(s)
- Xian-Qi Zhang
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People’s Republic of China
| | - Zhen-Wei Tang
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People’s Republic of China
| | - Jing Jing
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People’s Republic of China
| |
Collapse
|
2
|
Đorđević Betetto L, Bajuk V. Trigeminal trophic syndrome, a rare and often overlooked cause of facial ulceration: a case report and literature review. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2023. [DOI: 10.15570/actaapa.2023.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
|
3
|
Walton E, Wolner Z, Hammett J. Vaginal cuff pyoderma gangrenosum with associated ureteral stricture: A case report. Urol Case Rep 2021; 39:101826. [PMID: 34522619 PMCID: PMC8424502 DOI: 10.1016/j.eucr.2021.101826] [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] [Received: 08/03/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022] Open
Abstract
Pyoderma gangrenosum is a sterile inflammatory disease of unknown etiology characterized by recurrent cutaneous ulcers. It can occur in extracutaneous locations, especially at operative sites, and has been reported following gynecologic surgery. This report is the first case of pyoderma gangrenosum as a remote complication of pelvic surgery with associated ureteral stricture. It demonstrates the diagnostic challenge of this rare disease and the importance of broadening the differential diagnosis when apparent infections do not respond to treatment to minimize the morbidity of ineffective antibiotic and surgical interventions.
Collapse
Affiliation(s)
- Eric Walton
- Department of Urology, Emory University School of Medicine, 1365 Clifton Road NE, Building B, Suite B 1400, Atlanta, GA, 30322, USA
| | - Zachary Wolner
- Department of Dermatology, Emory University School of Medicine, 1525 Clifton Rd #3, Atlanta, GA, 30322, USA
| | - Jessica Hammett
- Department of Urology, Emory University School of Medicine, 1365 Clifton Road NE, Building B, Suite B 1400, Atlanta, GA, 30322, USA
| |
Collapse
|
4
|
DaCunha M, Siscos S, Downing M, Tarantino I, Hall J. Pyoderma gangrenosum controlled with rituximab. JAAD Case Rep 2019; 5:593-595. [PMID: 31312710 PMCID: PMC6610635 DOI: 10.1016/j.jdcr.2019.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Matthew DaCunha
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
| | - Spyros Siscos
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
| | - Malia Downing
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
| | - Isadore Tarantino
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
| | - John Hall
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
| |
Collapse
|
5
|
Kleinfelder RE, Hin N, Cubelli S, Snyder A, Kerdel F, Glick B. Multiple Facial Lesions of Recalcitrant Pyoderma Gangrenosum Successfully Treated with Adalimumab. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2019; 12:28-32. [PMID: 31320974 PMCID: PMC6561708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare, ulcerative, inflammatory skin disease that most commonly presents on the lower legs. Development of PG on the head and neck is exceedingly rare. We present the case of a 52-year-old man with no known history of underlying systemic disease who developed multiple facial lesions of PG that were refractory to both standard and alternative treatment modalities. Clearance of disease was ultimately achieved using adalimumab.
Collapse
Affiliation(s)
- Raymond E Kleinfelder
- Drs. Kleinfelder and Hin are with the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus, in Hialeah, Florida
- Dr. Cubelli is with St. John's Episcopal Hospital in Far Rockaway, New York
- Mr. Snyder is with Glick Skin Institute in Margate, Florida
- Dr. Kerdel is with the the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus in Hialeah, Florida; the Florida Academic Dermatology Center in Coral Gables, Florida; and Florida International University in Miami, Florida
- Dr. Glick is with the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus, in Hialeah, Florida and the Click Skin Institute in Margate, Florida
| | - Nady Hin
- Drs. Kleinfelder and Hin are with the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus, in Hialeah, Florida
- Dr. Cubelli is with St. John's Episcopal Hospital in Far Rockaway, New York
- Mr. Snyder is with Glick Skin Institute in Margate, Florida
- Dr. Kerdel is with the the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus in Hialeah, Florida; the Florida Academic Dermatology Center in Coral Gables, Florida; and Florida International University in Miami, Florida
- Dr. Glick is with the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus, in Hialeah, Florida and the Click Skin Institute in Margate, Florida
| | - Stefanie Cubelli
- Drs. Kleinfelder and Hin are with the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus, in Hialeah, Florida
- Dr. Cubelli is with St. John's Episcopal Hospital in Far Rockaway, New York
- Mr. Snyder is with Glick Skin Institute in Margate, Florida
- Dr. Kerdel is with the the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus in Hialeah, Florida; the Florida Academic Dermatology Center in Coral Gables, Florida; and Florida International University in Miami, Florida
- Dr. Glick is with the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus, in Hialeah, Florida and the Click Skin Institute in Margate, Florida
| | - Allan Snyder
- Drs. Kleinfelder and Hin are with the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus, in Hialeah, Florida
- Dr. Cubelli is with St. John's Episcopal Hospital in Far Rockaway, New York
- Mr. Snyder is with Glick Skin Institute in Margate, Florida
- Dr. Kerdel is with the the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus in Hialeah, Florida; the Florida Academic Dermatology Center in Coral Gables, Florida; and Florida International University in Miami, Florida
- Dr. Glick is with the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus, in Hialeah, Florida and the Click Skin Institute in Margate, Florida
| | - Francisco Kerdel
- Drs. Kleinfelder and Hin are with the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus, in Hialeah, Florida
- Dr. Cubelli is with St. John's Episcopal Hospital in Far Rockaway, New York
- Mr. Snyder is with Glick Skin Institute in Margate, Florida
- Dr. Kerdel is with the the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus in Hialeah, Florida; the Florida Academic Dermatology Center in Coral Gables, Florida; and Florida International University in Miami, Florida
- Dr. Glick is with the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus, in Hialeah, Florida and the Click Skin Institute in Margate, Florida
| | - Brad Glick
- Drs. Kleinfelder and Hin are with the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus, in Hialeah, Florida
- Dr. Cubelli is with St. John's Episcopal Hospital in Far Rockaway, New York
- Mr. Snyder is with Glick Skin Institute in Margate, Florida
- Dr. Kerdel is with the the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus in Hialeah, Florida; the Florida Academic Dermatology Center in Coral Gables, Florida; and Florida International University in Miami, Florida
- Dr. Glick is with the Dermatology Residency Program at the LECOMT/Larkin Community Hospital, Palm Springs Campus, in Hialeah, Florida and the Click Skin Institute in Margate, Florida
| |
Collapse
|
6
|
Niamtu J. Pyoderma Gangrenosum After Facelift and Otoplasty Surgery: Case Presentations and Literature Review. J Oral Maxillofac Surg 2019; 77:834-842. [DOI: 10.1016/j.joms.2018.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/11/2018] [Accepted: 10/11/2018] [Indexed: 12/19/2022]
|
7
|
Khan AU, Khachemoune A. Trigeminal trophic syndrome: an updated review. Int J Dermatol 2018; 58:530-537. [PMID: 29931799 DOI: 10.1111/ijd.14098] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/12/2018] [Accepted: 05/25/2018] [Indexed: 11/28/2022]
Abstract
Trigeminal trophic syndrome (TTS) is a rare disease process that is thought to occur after insult to the trigeminal nerve. The earliest descriptions of this condition were provided in the early 20th century, yet it remains relatively unknown, with approximately 200 cases since described. Most commonly seen in older women, TTS characteristically involves persistent facial ulceration with loss of sensation and paresthesia along the distribution of the trigeminal dermatome. Ulceration often occurs in the alar region, following self-manipulation in response to paresthesias. Time of onset of TTS after trigeminal insult may vary from weeks to decades, and emergence of ulceration may be associated with psychiatric disorders. Diagnosis is clinical and made by exclusion of similarly presenting conditions. Histology is nonspecific yet necessary to exclude other causes of facial ulceration. Although there is not yet a standard management strategy, a number of successful approaches have been reported including pharmaceutical and surgical interventions, installation of a protector, and transcutaneous nerve stimulation. However, because of the self-inflicted manifestations of this disorder, behavioral modifications remain of the utmost importance. This review serves to address the history, epidemiology, pathogenesis, clinical presentation, histology, diagnosis, differential diagnosis, and management options for TTS.
Collapse
Affiliation(s)
- Ayesha U Khan
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amor Khachemoune
- Veterans Affairs Medical Center, Brooklyn, NY, USA.,Department of Dermatology, SUNY Downstate, Brooklyn, NY, USA
| |
Collapse
|
8
|
Fortunato L, Barone S, Bennardo F, Giudice A. Management of Facial Pyoderma Gangrenosum Using Platelet-Rich Fibrin: A Technical Report. J Oral Maxillofac Surg 2018; 76:1460-1463. [PMID: 29425752 DOI: 10.1016/j.joms.2018.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
Abstract
This report describes a case of local pyoderma gangrenosum that was treated with short-term immunosuppressive therapy and the topical application of platelet-rich fibrin (PRF). Medical treatment included oral corticosteroid therapy and topical treatment with PRF in solid and liquid form. This therapy initially led to the reduction of the ulcer's size and an improvement in symptoms, until the ulcer was completely healed after a few weeks. A relapse was treated with only the application of PRF to the affected tissue with excellent recovery. The efficacy of PRF as a guide for wound healing is a result of the continuous release of growth factors involved in tissue repair mechanisms. PRF has proved to be suitable for the management of facial pyoderma gangrenosum while allowing a reduction in systemic corticosteroid therapy. The ease of preparation, low cost, and outpatient use make PRF an optimal scaffold for tissue healing processes.
Collapse
Affiliation(s)
- Leonzio Fortunato
- Associate Professor, School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Selene Barone
- Resident, School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Francesco Bennardo
- Resident, School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Amerigo Giudice
- Associate Professor, School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.
| |
Collapse
|
9
|
Gupta AS, Ortega-Loayza AG. Ocular pyoderma gangrenosum: A systematic review. J Am Acad Dermatol 2016; 76:512-518. [PMID: 27836332 DOI: 10.1016/j.jaad.2016.08.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a rare, ulcerative cutaneous disorder. Ophthalmic involvement in PG is atypical, but can have devastating consequences. OBJECTIVE We sought to characterize ocular PG to allow for earlier diagnosis and therapy. To our knowledge, this is the first systematic review summarizing this clinical variant. METHODS A systematic review was conducted using PubMed and Web of Science. Data were extracted and studies were qualitatively assessed and analyzed. RESULTS We identified all 34 cases of PG involving the eye and periorbital area, and categorized them into 4 different subtypes. Common presenting signs include ulceration, peripheral ulcerative keratitis, and decreased visual acuity. Although it is often difficult to biopsy ocular PG, histologic features are nonspecific. Combined therapy using corticosteroids and further surgical reconstruction as needed is the mainstay of treatment. Cases of the eye/orbit in particular should be treated aggressively, as these are more likely to relapse compared with cases of the periorbital area. LIMITATIONS Use of case reports, paucity of ocular PG cases, and heterogeneity of studies are limitations. CONCLUSION PG should be considered in the differential diagnosis of ulceration of ocular/periocular tissues. An aggressive, early, multimodal treatment strategy should be used to prevent relapse, especially in cases of the eye/orbit.
Collapse
Affiliation(s)
- Angela S Gupta
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Sciences University, Portland, Oregon.
| |
Collapse
|
10
|
|