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Varas-Rodríguez E, Cedeño F, Gonzalez-Diaz G, Vivas J, Salgueiro A, Dávila K, Nevarez Pomales O, Duyos O. Postsurgical Pyoderma Gangrenosum After Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00034. [PMID: 38015935 DOI: 10.2106/jbjs.cc.23.00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
CASE A 61-year-old woman with lower back and radicular leg pain underwent minimally invasive spinal fusion at L5-S1. By postoperative day 6, she exhibited erythema, wound dehiscence, and necrotic changes. Although a necrotizing infection was initially suspected, multiple debridements and antibiotic therapy failed to improve her condition. The patient was eventually diagnosed with pyoderma gangrenosum (PG) and was managed with immunosuppressants and extended wound care. CONCLUSION PG is a rare dermatosis that is often misdiagnosed, leading to inappropriate treatment, debridements, and additional complications. Prompt identification and multidisciplinary collaboration are key to preventing unnecessary interventions and achieving the best outcomes.
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Affiliation(s)
| | - Francis Cedeño
- School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | | | - Joshua Vivas
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Ariana Salgueiro
- Department of Environmental Sciences, Loyola University, New Orleans, Louisiana
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2
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Babakoohi S, Gu SL, Ehsan H, Markova A. Dermatologic complications in transplantation and cellular therapy for acute leukemia. Best Pract Res Clin Haematol 2023; 36:101464. [PMID: 37353285 PMCID: PMC10291442 DOI: 10.1016/j.beha.2023.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Abstract
Adoptive cellular immunotherapy, mainly hematopoietic stem cell transplant and CAR-T cell therapy have revolutionized treatment of patients with acute leukemia. Indications and inclusion criteria for these treatments have expanded in recent years. While these therapies are associated with significant improvements in disease response and overall survival, patients may experience adverse events from associated chemotherapy conditioning, engraftment, cytokine storm, supportive medications, and post-transplant maintenance targeted therapies. Supportive oncodermatology is a growing specialty to manage cutaneous toxicities resulting from the anti-cancer therapies. In this review, we summarize diagnosis and management of the common cutaneous adverse events including drug eruptions, graft-versus-host disease, neoplastic and paraneoplastic complications in patients undergoing cellular therapies.
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Affiliation(s)
- Shahab Babakoohi
- Levine Cancer Institute, Atrium Health Wake Forest Baptist, Charlotte, NC, USA.
| | - Stephanie L Gu
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Hamid Ehsan
- Levine Cancer Institute, Atrium Health Wake Forest Baptist, Charlotte, NC, USA
| | - Alina Markova
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA.
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Bal H, Subramanian S, Sharma YK, Lal S. A Case of Post-caesarean Pyoderma Gangrenosum. J Obstet Gynaecol India 2022; 72:372-375. [PMID: 36457428 PMCID: PMC9701299 DOI: 10.1007/s13224-021-01604-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- Himadri Bal
- Department of Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, 411018 India
| | - Supraja Subramanian
- Department of Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, 411018 India
| | - Y. K. Sharma
- Department of Dermatology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, 411018 India
| | - Swati Lal
- Department of Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, 411018 India
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4
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Owen BS, Pacult MA, Lee BS. Pyoderma Gangrenosum Masquerading as Wound Infection in the Early Postoperative Period After Lumbar Spine Deformity Correction Surgery. Cureus 2022; 14:e25545. [PMID: 35800799 PMCID: PMC9246455 DOI: 10.7759/cureus.25545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/05/2022] Open
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5
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Truong TV, Gruenberg B, Ciener DA, Butchee R. Hives and Fever in a 13-year-old Boy. Pediatr Rev 2022; 43:49-53. [PMID: 34970693 DOI: 10.1542/pir.2020-003848] [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: 11/24/2022]
Affiliation(s)
- Thang V Truong
- The Children's Hospital at OU Medical Center, Oklahoma City, OK.,University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | | | - Ryan Butchee
- The Children's Hospital at OU Medical Center, Oklahoma City, OK
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6
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Briffa J, Wang YTT, Murphy L, Bunker D, Kode G. Post-surgical pyoderma gangrenosum as a cause of unexplained wound breakdown. ANZ J Surg 2021; 92:865-867. [PMID: 34365724 DOI: 10.1111/ans.17130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/28/2022]
Affiliation(s)
- James Briffa
- Department of Plastic and Reconstructive Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Yu-Ting Tina Wang
- Department of Plastic and Reconstructive Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Lisa Murphy
- Department of Plastic and Reconstructive Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Daniel Bunker
- Department of Plastic and Reconstructive Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Gary Kode
- Department of Plastic and Reconstructive Surgery, Launceston General Hospital, Launceston, Tasmania, Australia
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7
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Bingoel AS, Krezdorn N, Kaltenborn A, Dastagir K, Jokuszies A, Mett TR, Vogt PM. The surgical approach to Pyoderma gangrenosum: A retrospective monocenter study. Wound Repair Regen 2021; 29:478-485. [PMID: 33835625 DOI: 10.1111/wrr.12918] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/15/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
Pyoderma gangrenosum is a diagnosis of exclusion. It occurs rarely and is frequently misdiagnosed. It can result in severe tissue loss, particularly in surgical units with little experience. Nevertheless, surgical treatment might be necessary for reconstruction, once the progression of these wounds is controlled. We aimed to characterize medical findings in Pyoderma patients with extensive defects to assess the surgical procedures and their outcome. A retrospective study was conducted at our centre over an 18-year period. Inclusion criteria were the diagnosis of Pyoderma gangrenosum and at least one surgical intervention. Descriptive statistics were used to analyse the data. Sixteen patients were included. The mean size of the lesions was noted with 12 × 8 cm. Surgical procedures comprised debridements/necrectomies, allograft conditioning, negative pressure wound therapy, skin grafts, and microvascular free flaps. Seven patients were discharged with healed wounds, six with minor wound healing disturbances. Three patients succumbed to their underlying diseases. Drug-based therapy can stop the progress of Pyoderma, but severe tissue loss can be a persistent problem. According to our data, reconstructive-surgical treatments (debridement, autologous and allogenous skin transplantation and microvascular free flaps) act as an integral component of the therapy and can be safe options for selected patients. Furthermore, we provide an algorithm that we follow at our department in severe cases.
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Affiliation(s)
- Alperen S Bingoel
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Nicco Krezdorn
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Alexander Kaltenborn
- Department of Trauma and Orthopedic Surgery, Plastic, Hand and Reconstructive Surgery, Armed Forces Hospital Westerstede, Westerstede, Germany
| | - Khaled Dastagir
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Andreas Jokuszies
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Tobias R Mett
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Peter M Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
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Aziret M, Kara Ş, Yaldız M, Köse N, Aşıkuzunoğlu F, Cevrioğlu AS. An extensive pyoderma gangrenosum mimicking necrotizing fasciitis: An unusual case report. Int J Surg Case Rep 2021; 81:105697. [PMID: 33691271 PMCID: PMC7944046 DOI: 10.1016/j.ijscr.2021.105697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Pyoderma Gangrenosum (PG) is a rare, benign and inflammatory disease characterized by ulcerative skin lesions. We report the successful management of an unusual case of PG following a caesarean section, with extensive cutaneous skin involvement and mimicking necrotizing fasciitis. Presentation of case A 36-year-old woman was admitted with extensive surgical site inflammation after a caesarean section. Despite antibiotic treatment and wound care, the clinical course deteriorated rapidly. Wound debridement following negative pressure closure was performed due to an immediate increase in skin necrosis. A diagnosis of PG was reached based on the absence of a positive wound culture, resistance to wound debridement and the histopathological results. A course of high-dose corticosteroids was started, and a successful clinical course was finally achieved. The patient is now in the 14th month of remission, with no recurrence. Discussion PG is often reported after bowel surgery, especially after complicated stoma or diverticulitis, breast surgery and occasionally after C-sections. The diagnosis of pyoderma gangrenosum may be challenging because of a wide variety of macroscopic features and its pronounced similarity to necrotizing fasciitis. Treatment with systemic corticosteroids is the most common management option, while surgical treatment is extremely controversial. Conclusion An extensive PG following surgery can mimic necrotizing fasciitis. An interdisciplinary treatment approach provides early diagnosis and effective treatment resulting in less morbidity.
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Affiliation(s)
- Mehmet Aziret
- Sakarya University Faculty of Medicine, Department of General Surgery Sakarya, Turkey.
| | - Şeyma Kara
- Sakarya University Faculty of Medicine, Department of Obstetrics and Gynecology Sakarya, Turkey
| | - Mahizer Yaldız
- Sakarya University Faculty of Medicine, Department of Dermatology Sakarya, Turkey
| | - Nur Köse
- Sakarya University Faculty of Medicine, Department of Pathology Sakarya, Turkey
| | - Feyza Aşıkuzunoğlu
- Sakarya University Faculty of Medicine, Department of General Surgery Sakarya, Turkey
| | - Arif Serhan Cevrioğlu
- Sakarya University Faculty of Medicine, Department of Obstetrics and Gynecology Sakarya, Turkey
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9
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Wang J, Prenner J, Wang W, Sakuraba A, Hyman N, Dalal S, Hurst R, Cohen RD, Umanskiy K, Shogan BD, Alpert L, Rubin DT, Colwell J, Pekow J. Risk factors and treatment outcomes of peristomal pyoderma gangrenosum in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2020; 51:1365-1372. [PMID: 32383278 DOI: 10.1111/apt.15766] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/12/2020] [Accepted: 04/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Insufficient data exist for peristomal pyoderma gangrenosum (PPG), which primarily affects patients with inflammatory bowel disease (IBD). AIMS To evaluate the risk factors and treatment response of PPG in IBD patients in a real-life cohort. METHODS Cases of PPG were identified retrospectively using ICD-9/10 codes in patients with IBD who had an ostomy at a tertiary care centre. Disease-specific characteristics were compared between groups with and without PPG, and response to therapy was evaluated in patients with PPG. RESULTS The cohort included 41 IBD patients with PPG and 123 IBD controls with an ostomy who never developed PPG. Patients with PPG were more likely to be female (76% vs 51%, P = 0.006), had higher BMIs (29.78 ± 0.89 vs 23.53 ± 0.51, P < 0.0001) and had increased usage of pouch belts (97% vs 71%, P = 0.0008) compared to controls. There were no differences in age at surgery (41.76 ± 2.60 vs 43.49 ± 1.50, P = 0.57) or IBD diagnosis (63% vs 54% Crohn's disease, P = 0.28) between PPG and controls. 85% of PPG patients achieved complete resolution with different treatments, including surgery. Complete resolution with topical corticosteroids and calcineurin inhibitors alone were low (14% and 13% respectively). Higher rates of complete resolution were reported with anti-tumour necrosis factor (TNF) agents (63%) and surgical interventions (80%). CONCLUSIONS Female gender, higher BMI and pouch belts were associated with increased risk of developing PPG. Most PPG cases resolved after treatment with the highest rates of complete resolution seen with anti-TNF agents and surgical intervention.
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Affiliation(s)
- Jingzhou Wang
- Department of Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Joshua Prenner
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Wenfei Wang
- Department of Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Atsushi Sakuraba
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Neil Hyman
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Sushila Dalal
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Roger Hurst
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Russell D Cohen
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | | | | | - Lindsay Alpert
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - David T Rubin
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Janice Colwell
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Joel Pekow
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
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10
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van Donkelaar CE, de Haan JMH, Lange JFM, de Vries M, Horváth B. Pseudo-wound infection after a caesarean section: Case report of unrecognized Pyoderma Gangrenosum. Int J Surg Case Rep 2020; 69:79-82. [PMID: 32305662 PMCID: PMC7171254 DOI: 10.1016/j.ijscr.2020.03.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/15/2020] [Accepted: 03/19/2020] [Indexed: 11/29/2022] Open
Abstract
Pyoderma Gangrenosum (PG) is a rare auto-inflammatory disease. It can develop after surgery due to the pathergy phenomena. Consider PG in the differential diagnosis of a suspected surgical wound infection. Avoid surgical treatment as long as the disease is active to reduce morbidity.
Background Pyoderma Gangrenosum (PG) is a rare auto-inflammatory disease, characterized by painful ulcerative skin-lesions often developing at sites of injury or surgery because of the typical pathergy phenomena. We describe an unusual case of PG after a caesarean section with excessive extra-cutaneous manifestation within internal organs. Presentation of case A 21-year-old Dutch primigravida developed signs of sepsis after a caesarean section. Despite antibiotic treatment, fast clinical deterioration occurred. Exploration of the wound showed necrosis of the uterus and surrounding tissues. Due to the progression of necrosis, consecutive debridement procedures were executed resulting in a substantial abdominal wall defect. The progressive clinical course of the necrosis combined with absence of positive wound cultures and histology of prominent interstitial neutrophilic infiltration, led to the diagnosis ‘Pyoderma Gangrenosum’. Treatment with high dose corticosteroids led to rapid regression of the disease. After several weeks, the abdominal wall defect was surgically corrected under systemic corticosteroid therapy. Discussion This case of PG is unique due to the excessive extra-cutaneous presentation, which contributed to delayed diagnosis. Several surgical interventions in the active stage of disease resulted in expansion of PG and substantial morbidity for the patient. Conclusion Post-operative PG can mimic infectious diseases, but treatment is substantially different. This case of extensive PG highlights the importance of timely recognition and treatment of the disease to reduce iatrogenic morbidity.
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Affiliation(s)
| | - Johanna M H de Haan
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Johan F M Lange
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Marjolijn de Vries
- Department of Obstetrics and Gynecology, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Barbara Horváth
- Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands
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Rare Presentation of Postsurgical Pyoderma Gangrenosum Presenting as Necrotizing Soft Tissue Infection. Adv Skin Wound Care 2020; 32:507-511. [PMID: 31498172 PMCID: PMC7328872 DOI: 10.1097/01.asw.0000579692.74662.bb] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis believed to be mediated by an autoimmune reaction. Typical treatment includes autolytic debridement, management of exudate, protection from trauma, and steroid therapy. A diagnosis of exclusion, PG is frequently mistaken for a wound infection, but antibiotics do not alleviate the condition. Incision and debridement has been observed to cause further spread of the lesions because of pathergy resulting from the additional trauma. This case report describes a patient who was misdiagnosed with necrotic soft tissue infection that was actually postsurgical PG.
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12
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Slocum AMY. A surgeon's nightmare: pyoderma gangrenosum with pathergy effect mimicking necrotising fasciitis. BMJ Case Rep 2017; 2017:bcr-2017-222145. [PMID: 29269363 DOI: 10.1136/bcr-2017-222145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A 53-year-old woman was admitted for vulval swelling and fever. She was initially diagnosed with vulval cellulitis and given parenteral antibiotics. Within 1 week, she developed necrotic-looking skin lesions extending from her vulva to her buttock. Emergency surgical debridement with diversion colostomy was performed in view of suspected necrotising fasciitis. Shortly after the surgery, she developed necrotic-looking skin lesions at the peripheral venous cannula insertion site, central line insertion site, and around her surgical wounds and stoma. A second surgical debridement was performed and shortly afterwards, similar skin lesions appeared around her surgical wounds. Her clinical progression was suggestive of pyoderma gangrenosum with pathergy effect. Hence, she was started on topical steroid, systemic steroid and immunosuppressant. The skin lesions responded well to medical therapy. Further systemic workup for conditions associated with this disease revealed findings suspicious for myelodysplastic syndrome.
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Affiliation(s)
- Amanda Mun Yee Slocum
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong, China
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Abstract
Owing to the wide variety and complexity of inflammatory skin diseases, inflammatory dermatopathology can be a challenging topic for dermatopathologists and general surgical pathologists alike. Following a basic tissue reaction pattern approach, this article reviews the most common and important entities of each pattern, with emphasis on differential diagnosis, diagnostic pitfalls, and appropriate workup when indicated. A few dermatologic emergencies are also discussed.
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Fong Y, Kauffmann RM, Marcinkowski E, Singh G, Schoellhammer HF. Dermatologic Emergencies. SURGICAL EMERGENCIES IN THE CANCER PATIENT 2017. [PMCID: PMC7122021 DOI: 10.1007/978-3-319-44025-5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yuman Fong
- Department of Surgery, City of Hope Medical Center, Duarte, California USA
| | | | - Emily Marcinkowski
- Surgical Oncology Hepatobiliary Surgery, City of Hope Medical Center, Duarte, California USA
| | - Gagandeep Singh
- Department of Surgery, City of Hope Medical Center, Durate, California USA
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Wagner RD, Nguyen HP, Tyring SK. Giant ulcerative lesion on the upper back: using a differential diagnosis to formulate a clinical approach. EINSTEIN-SAO PAULO 2016; 14:106-7. [PMID: 27074239 PMCID: PMC4872926 DOI: 10.1590/s1679-45082016ai3405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 12/21/2015] [Indexed: 11/28/2022] Open
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Massive pyoderma gangrenosum in a 77 year old female with Crohn's disease responsive to adalimumab. J Crohns Colitis 2013; 7:427-8. [PMID: 22926276 DOI: 10.1016/j.crohns.2012.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 07/27/2012] [Indexed: 02/08/2023]
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17
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Wu XR, Mukewar S, Kiran RP, Remzi FH, Hammel J, Shen B. Risk factors for peristomal pyoderma gangrenosum complicating inflammatory bowel disease. J Crohns Colitis 2013; 7:e171-7. [PMID: 22959399 DOI: 10.1016/j.crohns.2012.08.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 08/01/2012] [Accepted: 08/01/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Risk factors for peristomal pyoderma gangrenosum (PPG) are not well defined. The aim of this study was to evaluate risk factors associated with development of PPG. METHODS Both PPG patients and controls were obtained by searching a database of the Cleveland Clinic using the ICD-9 code from March 2005 to May 2011. The control group was selected by matching for underlying diseases and type of stoma in a ratio of 3:1. Univariate and multivariate analyses were performed. RESULTS A total of 15 PPG cases and 45 controls were included. The mean age at the time of PPG diagnosis was 46.0 ± 14.4 years. The underlying disease was Crohn's disease in 7 patients (46.7%), ulcerative colitis in 7 (46.7%) and indeterminate colitis in 1 (6.7%). Eleven patients (73.3%) had end ileostomy, 3 (20.0%) had loop ileostomy and 1 (6.7%) had colostomy. Eleven patients (73.3%) had active intestinal disease. In multivariate analysis, female gender, the presence of concurrent autoimmune disorders, and a high body mass index (BMI) were significantly associated with the presence of PPG, with odds ratios of 8.385 (95% confidence interval [CI]: 1.496-46.982, p=0.015), 6.882 (95% CI:1.438-32.941, p=0.016), and 9.895 (95% CI: 1.970-43.704, p=0.005), respectively. After a median follow-up of 12.8 (interquartile range: 7.9-20.1) months with appropriate therapy, PPG healed in 8 patients (53.3%) and improved in 7 (46.7%) patients, after treatment. CONCLUSIONS Female gender, the presence of autoimmune disorders and a high BMI appeared to be associated with an increased risk for the development of PPG in IBD patients.
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Affiliation(s)
- Xian-rui Wu
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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