Pyoderma gangrenosum in a patient with Crohn’s disease: Case report and a review of the literature

• Main Authors: Servet Güreşci, Yasar Nazlıgül, Ayse Serap Karadağ, Oktay Bulur
• Format: Article
• Language: English
• Published: Dicle University Medical School 2010-12-01
• Series: Dicle Medical Journal
• Subjects: Pyoderma gangrenosum; Crohn’s disease; corticosteroids.
• Online Access: http://www.dicle.edu.tr/fakulte/tip/dergi/yayin/374/20.pdf

Pyoderma gangrenosum is a rare neutrophilic noninfectious dermatose. Etiopathogenesis remains unclear, but in half of cases, there is an associated underlying disease. Inflammatory bowel disease is the most common underlying disorder. Systemic immunosuppressive or immunomodulator drugs and some topical agents are used in treatment of pyoderma gangrenosum. Systemic corticosteroids are the first-choice of treatment. We reported a case with Crohn’s disease associated with pyoderma gangrenosum. She was successfully treated with oral methyl prednisolon. The case was a 54-year-old woman who admitted to hospital because of erythematous, painful plaques on the right and left pretibial surfaces. She had a history of Crohn’s disease, diabetes mellitus, and hypertension. An elevated white blood cell count (13500/μL) and high erythrocyte sedimentation rate (120 mm/h) were detected. A regime of broad-spectrum antibiotics was started, but response was poor. Histopathological assessment of biopsy specimens showed necrosis, severe edema and erythrocyte extravasations in superficial dermis, regenerative changes in adjacent epithelium, and mixed inflammatory reaction surrounding necrosis in the inner part of the dermis. Based on these clinical and laboratory findings, poor response to antibiotics and underlying disease; her skin lesions were considered as pyoderma gangrenosum. Oral methylprednisolone was started and her skin lesions improved. The steroid dose was tapered and finally stopped under outpatient follow-up. In conclusion, our patient also showed that corticosteroids continue to be the first-choice therapy in pyoderma gangrenosum.