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Borda LJ, Saal RC, Encarnacion INM, Smith RJ. Prevalence of pathergy after surgical procedures in patients with history of pyoderma gangrenosum. Arch Dermatol Res 2024; 316:93. [PMID: 38416224 DOI: 10.1007/s00403-024-02831-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/22/2023] [Accepted: 02/03/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Luis J Borda
- Department of Dermatology, Eastern Virginia Medical School, 721 Fairfax Ave, Suite 200, Norfolk, VA, 23507, USA
| | - Ryan C Saal
- Department of Dermatology, Eastern Virginia Medical School, 721 Fairfax Ave, Suite 200, Norfolk, VA, 23507, USA.
| | - Iain Noel M Encarnacion
- Department of Dermatology, Eastern Virginia Medical School, 721 Fairfax Ave, Suite 200, Norfolk, VA, 23507, USA
| | - Robert J Smith
- Department of Dermatology, Eastern Virginia Medical School, 721 Fairfax Ave, Suite 200, Norfolk, VA, 23507, USA
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Kluger N, Del Giudice P. First case of Sweet's syndrome after tattooing. Ann Dermatol Venereol 2022; 149:279-280. [PMID: 35752495 DOI: 10.1016/j.annder.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/02/2021] [Accepted: 03/02/2022] [Indexed: 12/30/2022]
Affiliation(s)
- N Kluger
- Tattoo unit, Dermatology Department, Hôpital Bichat-Claude-Bernard, Assistance Publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Departments of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, 00029 Hus, Finland
| | - P Del Giudice
- Departments of Dermatology and Infectious Diseases, Centre Hospitalier Intercommunal de Fréjus-Saint-Raphaël, 83600 Fréjus, France.
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Jones JM, Bastick JC, Schadt CR. Clinical Challenge in Urology: A Nonhealing Wound on the Glans Penis. Urology 2022:S0090-4295(22)00591-X. [PMID: 35843355 DOI: 10.1016/j.urology.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022]
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Loomis R, Merrit M, Aleshin MA, Graw G, Lee G, Graw B. Pyoderma Gangrenosum After Bilateral Total Knee Arthroplasty. Arthroplast Today 2021; 11:73-79. [PMID: 34485653 PMCID: PMC8397920 DOI: 10.1016/j.artd.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022] Open
Abstract
Pyoderma gangrenosum is a neutrophilic dermatosis, which mimics both infection and necrotizing fasciitis, that can present after surgical interventions. We present the case of a 62-year-old male who underwent one-stage bilateral total knee arthroplasty. Nine days after the surgery, he presented with wound breakdown, high fever, and elevated white blood cell count. Repeated debridement was performed, and empiric antibiotics were given. All tissue cultures and aspirates remained negative throughout treatment course, and the patient remained unresponsive to therapy. The patient was eventually diagnosed with pyoderma gangrenosum after infectious etiologies were ruled out and after a skin biopsy and dermatologic consultation. His condition rapidly improved after treatment with corticosteroids, and soft-tissue defects were repaired with skin substitute and full-thickness skin grafting. In patients with aseptic wound breakdown after total knee arthroplasty, pyoderma gangrenosum is a rare but devastating complication and should be considered.
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Affiliation(s)
- Reilly Loomis
- Palo Alto Medical Foundation, Center for Total Joint Replacement, Palo Alto, CA
| | - Mellanie Merrit
- Sequoia Hospital, Center for Joint Replacement, Redwood City, CA
| | | | - Grace Graw
- Department of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA
| | - Gordon Lee
- Department of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA
| | - Bradley Graw
- Palo Alto Medical Foundation, Center for Total Joint Replacement, Palo Alto, CA
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Nowowiejska J, Baran A, Krahel JA, Flisiak I. Behçet's Disease in a Polish Patient: A Case Report. Dermatol Ther (Heidelb) 2021; 11:1435-1441. [PMID: 34053033 PMCID: PMC8322377 DOI: 10.1007/s13555-021-00551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/07/2021] [Indexed: 12/01/2022] Open
Abstract
Behçet's disease (BD) is a systemic autoinflammatory vasculitis. It occurs predominantly in Turkey but very rarely in Europe. The clinical manifestations of BD involve the skin and mucosal membranes; cardiovascular, gastrointestinal and nervous systems; and the eyes and joints. A 26-year-old man was repeatedly hospitalized at the Department of Dermatology of the Medical University of Bialystok. He had a family history of family members' deaths from unknown cause and a long personal history of recurring headaches and nonspecific pain in the chest as well as a 2-year history of recurring painful erosions on the oral mucosa. Recently, before admission to hospital, another erosion had appeared on the scrotum, which rapidly evolved into a painful ulceration. The patient also presented a large erosion in the area of the right hip and acne lesions. He consulted doctors of different specialties and underwent laboratory and imaging tests. Considering the symptoms, BD was diagnosed. Azathioprine was introduced, along with topical treatment. Great improvement of the skin lesions was achieved. He was later admitted to the department a few times for follow-up visits and remains in good general condition. BD is an extremely rare disease in Europe, especially in Poland. The fact that BD is a rare disease outside Asia leads to lower awareness and the possibility of not considering it in the differential diagnosis. The great diversity of symptoms also causes difficulties in tracking this disease. The various manifestations of BD require a broad spectrum of additional tests and an interdisciplinary approach to the patient.
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Affiliation(s)
- Julia Nowowiejska
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540 Białystok, Poland
| | - Anna Baran
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540 Białystok, Poland
| | - Julita A. Krahel
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540 Białystok, Poland
| | - Iwona Flisiak
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540 Białystok, Poland
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Vernaci GM, Meroni M, Dieci MV, Saibene T, Montesco MC, Orvieto E, Cattelan A, Ghiotto C, Miglietta F, Guarneri V, Cagol M. Postsurgical Pyoderma Gangrenosum in a Breast Cancer Patient: A Case Report and Literature Review. Case Rep Oncol 2021; 14:160-164. [PMID: 33776698 PMCID: PMC7983549 DOI: 10.1159/000509745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 11/19/2022] Open
Abstract
Pyoderma gangrenosum is a rare skin necrotizing disease that can arise on a site of surgical trauma. Its pathogenesis has recently been related to dysregulation of the immune system, with inflammatory bowel disease representing the most commonly underlying systemic conditions. Several authors have also reported an association with solid malignancies (especially gastrointestinal and breast cancer). We describe the case of a 39-year-old patient diagnosed with a locally advanced, triple-negative breast cancer who developed a pyoderma gangrenosum on the surgical wound after a CVC implant with systemic complications. As the diagnosis and management of postsurgical pyoderma gangrenosum can be challenging for clinicians, underlying conditions as autoimmune disease and solid tumors have to be considered in order to guide treatment.
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Affiliation(s)
- Grazia Maria Vernaci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Muzio Meroni
- Anaesthesiology Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Tania Saibene
- Breast Surgery Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | | | - Enrico Orvieto
- Department of Pathology, Azienda Ospedaliera di Rovigo, Rovigo, Italy
| | - Annamaria Cattelan
- Unit of Infectious Disease, Department of Internal Medicine, Azienda Ospedaliera Universitaria di Padova, Padua, Italy
| | - Cristina Ghiotto
- Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Federica Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Matteo Cagol
- Breast Surgery Unit, Istituto Oncologico Veneto IRCCS, Padua, Italy
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Accetta J, Powell E, Boh E, Bull L, Kadi A, Luk A. Isavuconazonium for the treatment of Purpureocillium lilacinum infection in a patient with pyoderma gangrenosum. Med Mycol Case Rep 2020; 29:18-21. [PMID: 32547913 PMCID: PMC7286926 DOI: 10.1016/j.mmcr.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022] Open
Abstract
Purpureocillium lilacinum is a rare but emerging pathogen in immunocompromised patients that primarily infects the skin and subcutaneous tissue. We present a novel case of Purpureocillium lilacinum infection in a patient with pyoderma gangrenosum who was successfully treated with isavuconazonium, followed by a literature review of 13 total cases of infection with Purpureocillium lilacinum gathered from a review of the PubMed database. Previous reports have utilized voriconazole, an antifungal with significant toxic side effects. Our case highlights the importance of culture and biopsy in patients with pyoderma gangrenosum who are unresponsive to standard treatment irrespective of pathergy risk.
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Affiliation(s)
- Julia Accetta
- Tulane University, Department of Medicine, 1415 Tulane Avenue, 70112, New Orleans, United States
- Corresponding author.
| | - Emily Powell
- Tulane University, Department of Dermatology, 1415 Tulane Avenue, 70112, New Orleans, United States
| | - Erin Boh
- Tulane University, Department of Dermatology, 1415 Tulane Avenue, 70112, New Orleans, United States
| | - Lisa Bull
- Tulane University, Department of Pathology, 1415 Tulane Avenue, 70112, New Orleans, United States
| | - Abida Kadi
- Tulane University, Department of Pathology, 1415 Tulane Avenue, 70112, New Orleans, United States
| | - Alfred Luk
- Tulane University, Department of Medicine, 1415 Tulane Avenue, 70112, New Orleans, United States
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Antoni A, Trautinger F, Heinz T, Hajdu S. Hemiarthroplasty in a patient with femoral neck fracture and pyoderma gangrenosum: a case report and review of the literature. J Med Case Rep 2020; 14:8. [PMID: 31931877 PMCID: PMC6958711 DOI: 10.1186/s13256-019-2329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
Background Pyoderma gangrenosum is a rare ulcerating skin disease of unknown etiology, making its coincidence with orthopedic trauma a rare challenge. Patients are at risk of progression of the existing lesions and development of new lesions upon skin injury when surgical procedures are performed. To our knowledge, this is the first report in the literature of disease unrelated surgery during active pyoderma gangrenosum. Case presentation We present a case of femoral neck fracture in a Caucasian patient with concurrent pyoderma gangrenosum localized in the axilla. Hemiarthroplasty was safely performed after disease activity was reduced with systemic corticosteroids. Tissue-protective wound closure was used together with perioperative corticosteroids and antibiotics. No signs of pyoderma gangrenosum developed at the surgical wound site, and the axillary lesions showed constant improvement until healing with scar tissue. Conclusions In our patient, the preoperative steroid treatment, perioperative antibiotics, and soft tissue protective surgical technique led to successful management of this rare coincidence.
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Affiliation(s)
- Anna Antoni
- Department of Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Franz Trautinger
- Karl Landsteiner Institute of Dermatological Research, Karl Landsteiner Society, Franziskanergasse 4a, 3100, St. Pölten, Austria
| | - Thomas Heinz
- Department of Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stefan Hajdu
- Department of Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Abstract
The diagnosis of pyoderma gangraenosum was previously made as a diagnosis of exclusion. For this reason repeated attempts have been made in recent years to develop new diagnostic scores, whereby the typical clinical and anamnestic aspects were usually taken into account and the relevant differential diagnoses were excluded. With the PARACELSUS score an evaluated diagnostic score was presented for the first time. The main diagnostic criteria of this score are a rapidly progressing disease, the assessment of relevant differential diagnoses and reddish-violaceous wound borders. If these criteria are or were present 3 points are given for each criterion. Secondary criteria with a score of 2 for each of the aspects are amelioration by immunosuppressant drugs, characteristically irregular (bizarre) ulcer shape, extreme pain of >4 on a visual analog scale and localization of the lesion at the site of trauma (pathergy phenomenon). Additional criteria worth one point are suppurative inflammation in histopathology, undermined deep wound borders and the association of relevant systemic diseases. An additive score of ≥10 makes the diagnosis of pyoderma gangraenosum very likely. The newly developed and evaluated PARACELSUS score is an easy to use clinical tool to objectify securing the diagnosis of pyoderma gangraenosum.
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Affiliation(s)
- Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
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Naciri I, Meziane M, Benzekri L, Ghaouti M, Senouci K, Hassam B. [Recurrent postpartum pyoderma gangrenosum and fatal cardiomyopathy]. Ann Dermatol Venereol 2017; 145:261-265. [PMID: 29223609 DOI: 10.1016/j.annder.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/10/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND We report a case of recurrent post-partum pyoderma gangrenosum (PG) complicated by post-partum cardiomyopathy (PPCM). PATIENTS AND METHODS A 23-year-old woman presented with a previous medical history of aseptic abscess of the left breast in her fourth pregnancy, which developed after surgical drainage of an inflammatory ulceration treated by atraumatic topical care. During her fifth pregnancy, the patient presented a large and painful ulceration in relation to the scar of the Caesarean section, despite the introduction of broad-spectrum antibiotic therapy. Bacteriological samples were negative. Histological examination militated in favor of PG. One week after initiation of corticosteroid therapy, the patient suddenly showed signs of heart failure. Based on trans-thoracic echocardiography PPCM was diagnosed, and the outcome was fatal. DISCUSSION This observation raises the question of the relationship between PG and pregnancy and describes the association of PG and PPCM. PG occurs rarely during pregnancy and it may be induced by the rise in G-CSF levels found in pregnant women. The association with PPCM seen in our patient could have been due to the development of an anti-angiogenic climate at the end of pregnancy, together with inflammatory myocardial aggression linked to the PG.
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Affiliation(s)
- I Naciri
- Service de dermatologie et vénérologie, faculté de médecine et de pharmacie, université Mohammed V, centre hospitalier universitaire Ibn Sina, BP 6527, 10100 Rabat, Maroc.
| | - M Meziane
- Service de dermatologie et vénérologie, faculté de médecine et de pharmacie, université Mohammed V, centre hospitalier universitaire Ibn Sina, BP 6527, 10100 Rabat, Maroc
| | - L Benzekri
- Service de dermatologie et vénérologie, faculté de médecine et de pharmacie, université Mohammed V, centre hospitalier universitaire Ibn Sina, BP 6527, 10100 Rabat, Maroc
| | - M Ghaouti
- Centre d'anatomie pathologique des Nations Unies, rue Ibn Hanbal, 10080 Rabat, Maroc
| | - K Senouci
- Service de dermatologie et vénérologie, faculté de médecine et de pharmacie, université Mohammed V, centre hospitalier universitaire Ibn Sina, BP 6527, 10100 Rabat, Maroc
| | - B Hassam
- Service de dermatologie et vénérologie, faculté de médecine et de pharmacie, université Mohammed V, centre hospitalier universitaire Ibn Sina, BP 6527, 10100 Rabat, Maroc
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Patel DK, Locke M, Jarrett P. Pyoderma gangrenosum with pathergy: A potentially significant complication following breast reconstruction. J Plast Reconstr Aesthet Surg 2017; 70:884-92. [PMID: 28476284 DOI: 10.1016/j.bjps.2017.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/27/2017] [Accepted: 03/29/2017] [Indexed: 11/23/2022]
Abstract
The failure of postoperative surgical site infection to resolve after appropriate antibiotic therapy should alert the clinician to other diagnoses. Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis that is typically characterized by necrotizing ulceration. PG can be exacerbated by minor trauma leading to exaggerated skin injury, a condition known as pathergy. We present a case series of PG arising after immediate reconstruction for breast oncological surgery from 1st January 2006 to 1st September 2014. 395 immediate breast reconstructions were performed in 335 patients. Three cases of post-surgical PG were identified (0.9%), all in the setting of mastectomy for breast cancer. Two cases underwent immediate reconstruction with pedicled transverse rectus abdominus myocutaneous flaps, and one underwent submuscular expander insertion. A mean delay of 6.3 days was observed from first presentation of symptoms to diagnosis of PG. Immunosuppressants commonly used included methylprednisolone, prednisone, and ciclosporin, with good success at halting disease progress. Significant scarring affected all three women. Once the disease was deemed quiescent, intravenous immunoglobulin used in the perioperative period for further surgical procedures provided favorable results. A diagnostic algorithm is suggested to guide surgeons in investigations and management when post-surgical PG is suspected.
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Yamamoto T. Pyoderma gangrenosum: An important dermatologic condition occasionally associated with rheumatic diseases. World J Rheumatol 2015; 5:101-107. [DOI: 10.5499/wjr.v5.i2.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 04/29/2015] [Indexed: 02/06/2023] Open
Abstract
Pyoderma gangrenosum (PG) presents with refractory, sterile, deep ulcers most often on the lower legs. Clinically, PG exhibits four types, i.e., ulcerative, bullous, pustular, and vegetative types. PG may be triggered by surgical operation or even by minor iatrogenic procedures such as needle prick or catheter insertion, which is well-known as pathergy. PG is sometimes seen in association with several systemic diseases including rheumatoid arthritis (RA), inflammatory bowel disease, hematologic malignancy, and Takayasu’s arteritis. In particular, various cutaneous manifestations are induced in association with RA by virtue of the activation of inflammatory cells (neutrophils, lymphocytes, macrophages), vasculopathy, vasculitis, drugs, and so on. Clinical appearances of ulcerative PG mimic rheumatoid vasculitis or leg ulcers due to impaired circulation in patients with RA. In addition, patients with PG sometimes develop joint manifestations as well. Therefore, it is necessary for not only dermatologists but also rheumatologists to understand PG.
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