A Case of Pyoderma Vegetans and the Follicular Occlusion Triad

Abstract

A case of pyoderma vegetans (PYV) and hidradenitis suppurativa (HS) is described. Our patient had a previous history of perifolliculitis capitis abscedens et suffodiens and acne conglobata. Direct immunofluorescence findings ruled out pemphigus vegetans and suggested a potential pathogenic mechanism.

Pyoderma Vegetans

“…Our patient had a history of hidradenitis suppurativa, similar to a patient reported by Boyd and Zemtsov. 13 They proposed that hidradenitis suppurativa may have caused an immune complex deposition in the skin which precipitated the pyoderma vegetans reaction; the nonspecific immunoreactant deposition by direct immunofluorescence in our patient may be interpreted as in support of their theory. 13 Our patient had no evident underlying immunocompromising condition.…”

“…1,2,10 North American blastomycosis and pemphigus vegetans, an autoimmune disorder that is a rare variant of pemphigus vulgaris, closely resemble pyoderma vegetans clinically. 2,[12][13][14] Other deep fungal infections, such as coccidioidomycosis and phycomycosis, may rarely appear similar to pyoderma vegetans. 2 Botryomycosis is a rare bacterial infection that may mimic fungal disease and may also resemble pyoderma vegetans.…”

“…Direct and indirect immunofluorescence can distinguish between pyoderma vegetans and pemphigus vegetans. 12,13 Our patient met the clinical and histological criteria for the diagnosis of pyoderma vegetans. Our patient had a history of hidradenitis suppurativa, similar to a patient reported by Boyd and Zemtsov.…”

“…Laboratory examination revealed red blood cell count 3.51 M/ᮀ L [4.20-5.40], hemoglobin 10.0 g/dL [12][13][14][15][16] Abdominal ultrasound examination showed hepatomegaly with probable fatty infiltration and no evidence of hydronephrosis. A chest roentgenogram revealed no abnormalities.…”

Pyoderma Vegetans Associated with Severe Psoriatic Arthritis: Good Response to Etanercept

“…HIV infection [10], malignant tumors, i.e. lymphomas [11], leukemia [12], carcinomas [13], alcoholism, nutritional deficit, diabetes mellitus [14], or therapy with immunosuppressive agents [4], and even in other situations such as bowel inflammatory disease [15, 16], and acne conglobata and follicular occlusion triad [17]. Treatment of this condition is usually very difficult.…”