Pyoderma gangrenosum and ulcerative colitis in the tropics

Abstract

Pyoderma gangrenosum is a rare inflammatory skin condition, characterized by progressive and recurrent skin ulceration. There may be rapidly enlarging, painful ulcers with undermined edges and a necrotic, hemorrhagic base. Disorders classically associated with pyoderma gangrenosum include rheumatoid arthritis, inflammatory bowel disease, paraproteinemia and myeloproliferative disorders. There have been some reports of the occurrence of pyoderma gangrenosum in Africa, and in Nigeria, but only one specifically reported pyoderma gangrenosum in association with ulcerative colitis. We report on a 45-year-old man who presented with pyoderma gangrenosum associated with ulcerative colitis; the second report in Nigeria. The skin lesions were managed with daily honey wound dressings. Oral dapsone and prednisolone were started. The frequency of the bloody diarrhea decreased, and was completely resolved by the second week after admission. The ulcers also showed accelerated healing. The goal of therapy is directed towards the associated systemic disorder, if present. Key-words:Pyoderma gangrenosum. Rectal bleeding. Bloody diarrhea. Colitis. RESUMOPioderma gangrenoso é uma rara forma de inflamação dermatológica, caracterizada por ulceração progressiva e recorrente da pele. Pode ocorrer rápida formação de úlceras dolorosas expansivas, com bordas solapadas e base necrótica e hemorrágica. Condições classicamente associadas com pioderma gangrenoso incluem artrite reumatóide, doença inflamatória intestinal, paraproteinemia e doenças mieloproliferativas. Existem alguns relatos da ocorrência de pioderma gangrenoso na África e na Nigéria, mas apenas um relato específico da associação de pioderma gangrenoso e colite ulcerativa. Os autores relatam o caso de um homem de 45 anos que apresentou pioderma gangrenoso associado a colite ulcerativa, sendo este o segundo relato na Nigéria. As lesões de pele foram tratadas com curativos diários de mel. Foram utilizadas dapsona e prednisona via oral. A freqüência de diarréia sanguinolenta diminuiu e se resolveu completamente até a segunda semana após a admissão. As úlceras também mostraram rápida cicatrização. A meta do tratamento deve abordar também a doença sistêmica associada, quando presente. Pyoderma gangrenosum is a type of painful cutaneous ulcer associated with an underlying systemic disease in the majority of cases (including inflammatory bowel disease) 6 . It is a rare inflammatory skin condition, characterized by progressive and recurrent skin ulceration, often representing a pathergy response 20 . Palavras-chaves: CASE REPORTA 45-year-old man presented with a one-month history of rectal bleeding and a one-week history of lower abdominal pain in the suprapubic region and left iliac fossa. He started passing mucoid, bloody and watery stools two weeks prior to presentation. He also had low-grade fever for a week and vomiting of two days duration; the vomitus contained recently ingested meals, but there was no hematemesis, nausea or abdominal swelling. He had taken alternative med...

Systematic review: IBD-associated pyoderma gangrenosum in the biologic era, the response to therapy

“…Of the 17 patients on no therapy at PG onset, 16 healed, seven with first‐line therapy (topical/oral steroids ± dapsone, mesalazine (mesalamine), steroids + ciclosporin, steroid + 5‐ASA). Ten required a second‐line therapy, with nine responding.…”

“…20 A good response to combination therapy including steroids was seen in only five of 24 cases (<20%). The successful use of steroid was in combination therapy with dapsone in one case 21 and two cases with 5-ASA. 23,24 One case responded after addition of mesalazine to oral steroids.…”

Inflammatory bowel disease in Nigerians: Still a rare diagnosis?

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“…In the United States adult population (18years and above), the overall prevalence of Inflammatory bowel disease was 478.4 per 100,000 people in 2016; the prevalence rates of Ulcerative Colitis and Crohn's Disease were 181.1 per 100,000 people and 197.7 per 100,000 people respectively [3] . Ulcerative colitis is reportedly rare in Black Africans [4,5] and indeed Nigerians [6,7,8] compared to Western populations [9,10,11] . There is no national data on the prevalence of Ulcerative Colitis in Nigeria; only few reports are available, mainly as case reports and case series [12,13,14,15] .…”