Atypical pyoderma gangrenosum in inflammatory bowel disease: A severe diagnostic challenge

Abstract

Pyoderma gangrenosum (PG) is a rare inflammatory and ulcerative disease of the skin of unknown etiology. Diagnosis of PG is based on clinical and histological data and requires the exclusion of other ulcerative diseases of the skin. There is an atypical form of PG that appears generally associated with hematological malignancies and rarely has been described in patients with inflammatory bowel disease (IBD). We describe the case of a patient diagnosed with IBD in whom symptomatology was mainly extraintestinal as atypical PG. Case reportA 39-year-old man was referred to our hospital complaining of diarrhea consisting in passage of six to eight liquid stools containing mucus and small amounts of blood each day. One year before, he had been diagnosed of IBD, likely ulcerative colitis, and was treated with corticosteroids and topical 5-aminosalicilates. At the time of hospitalization, in addition to diarrhea, he showed fever (38 ºC), anemia, leukocytosis and elevated reactive C protein serum levels (20.4 ng/mL). Physical examination revealed the presence of a perianal fistula. The colonoscopy demonstrated hyperemia, edema, friability, and granularity, as well as pinpoint ulceration of the colonic mucosa. These changes were diffuse and extended from the rectum throughout the left colon. Histologicaly, it displayed changes consistent with IBD. The patient was treated with high