Heterogeneity of blastomycosis‐like pyoderma: A selection of cases from the last 35 years

Scuderi, Salvatore; O’Brien, Blake; Robertson, Ivan; Weedon, David

doi:10.1111/ajd.12446

Cited by 11 publications

(32 citation statements)

References 14 publications

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“…Three patients had multiple lesions at clinical presentation (8). Our patient also belongs to el- (8). Our patient also belongs to elderly population with more than one lesion.…”

Section: Discussionmentioning

confidence: 74%

Pyoderma Vegetans – a Case Report

Jevremović

Ilijin

Kostić

et al. 2017

Serbian Journal of Dermatology and Venereology

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Pyoderma vegetans (PV) or blastomycosis-like pyoderma (BLP) is a chronic inflammatory disease, by some authors considered a rare variety of pyoderma gangrenosum (PG), and others describe it as a distinct entity. It commonly presents with verrucous plaques with multiple pustules. The etiology of this disease is unknown, but it has been connected with staphylococcal and streptococcal infections, inflammatory bowel disease, hematological diseases, primary immunodeficiency, alcoholism, and nutritional deficit. Here we present a 66-year-old, otherwise healthy female, with a 2-year-long history of well-defined, vegetative livid plaques with multiple pustules on the dorsal side of both hands. Histopathological analysis of the skin biopsy of the hand showed chronic inflammation and microabscesses, ruptured follicular cysts and follicular pseudoepitheliomatous hyperplasia. Treatment with anti-tuberculosis drugs and antibiotics showed to be ineffective, as well as the treatment with systemic corticosteroids, dapsone and cyclosporine. Itraconazole was given for its immunomodulatory effects and findings of Penicillium species in one of the swabs, which led to partial regression of lesions. Since the treatment did not lead to complete resolution, acitretin was indicated 3 months later, but the patient was lost to follow-up.

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“…Three patients had multiple lesions at clinical presentation (8). Our patient also belongs to el- (8). Our patient also belongs to elderly population with more than one lesion.…”

Section: Discussionmentioning

confidence: 74%

Pyoderma Vegetans – a Case Report

Jevremović

Ilijin

Kostić

et al. 2017

Serbian Journal of Dermatology and Venereology

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“…abscesses may also be present [10]. The differential diagnosis includes blastomycosis and other deep fungal infections, halogenoderma, pemphigus vegetans, tuberculosis verrucosa cutis, pyoderma gangrenosum, mycobacterial infections, giant keratoacanthoma, and squamous cell carcinoma [2,4,[7][8][9][10][11][12]. Our patient had four of the six criteria for BLP established by Su et al In accordance with the pertinent literature, we refrained from preforming fungal serology and blood halogen level testing.…”

Section: Case Reportmentioning

confidence: 97%

“…The most commonly reported pathogen is Staphylococcus aureus [2]. Additionally, β-hemolytic streptococci, Pseudomonas aeruginosa, and citrobacter species have been reported [1].…”

Section: Case Reportmentioning

confidence: 99%

“…Blastomycosis-like pyoderma (BLP) is a rare chronic form of pyoderma that presents with one or more large, indurated, verrucous plaques studded with pustules and draining sinuses [1,2]. This slowgrowing, vegetative infection typically presents similarly to the cutaneous manifestations of blastomycosis, a dimorphic fungi prevalent in the Ohio and Mississippi river valleys of North America.…”

Section: Introductionmentioning

confidence: 99%

“…There are cases of BLP arising at areas of local disturbance such as sun exposure, trauma and tattoo in immunocompetent persons [2,3,7].…”

Section: Introductionmentioning

confidence: 99%

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Blastomycosis-Like Pyoderma in a Patient with Syphilis and HIV Resolving with Antibiotic Therapy

Jetter¹,

Juhl²,

Tsoukasc³

2017

J Clin Case Rep

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Blastomycosis-like pyoderma (BLP) is a rare, exaggerated, vegetative tissue reaction that occurs in patients with local or systemic immune dysregulation. Reported causes of immune compromise include human immunodeficiency virus, malnutrition, alcoholism, leukemia, immunosuppressant use, radiation therapy, and others. Nearly all cases involve an underlying, prolonged pyogenic bacterial infection. Historically monotherapy with systemic antibiotics requires long-term treatment and often fails. We describe a case of a male patient with BLP of the face and scalp, which cultured positive for methicillin-resistant Staphylococcus aureus (MRSA). Subsequent evaluation uncovered a concurrent Treponema pallidum and HIV infections. Treatment of the MRSA with a short course of doxycycline and the syphilis with penicillin, resulted in complete resolution of the skin lesions. Highly Active Anti-Retroviral Therapy for HIV was initiated after the skin lesions had cleared. Resolution of BLP by antibiotic therapy alone in the context of untreated HIV leads the authors to postulate that syphilis may have been the relevant factor contributing to his immune dysregulation.

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