Pyoderma gangrenosum as a first presentation of inflammatory bowel disease

Abstract

Up to 40% of patients with inflammatory bowel disease (IBD) develop an extraintestinal manifestation of the disease with the skin being the most commonly involved organ. Pyoderma gangrenosum (PG), an autoinflammatory non-infectious neutrophilic dermatosis, occurs in 1–2% of patients with IBD. PG can follow a course independent to that of the bowel disease, however, most reported cases describe PG occurring in patients with an established diagnosis of IBD. We present a case of a young patient who presented with axillary skin ulceration, which was subsequently diagnosed as PG. On further investigation for a possible underlying cause, she was found to have Crohn's disease. She had not developed any preceding change in her bowels and did not have abdominal pain; the IBD was diagnosed on endoscopic findings. This case is also unusual for the distribution of the PG lesions that typically occur in the lower limbs.

Pyoderma Gangrenosum in Pediatrics. About a Case

“…La piel es uno de los órganos extraintestinales más comúnmente afectado en las enfermedades inflamatorias intestinales (colitis ulcerosa; Enfermedad de Chron). Hasta el 40% de los pacientes con enfermedad inflamatoria intestinal desarrollan manifestaciones extraintestinales de la enfermedad (8). Sheldom et al (3,9) encontraron PG en el 4-5% de los casos de colitis ulcerosa y hasta el 1.2-2% de casos en la enfermedad de Chron.…”

“…En nuestro caso la niña aún no presentaba diagnóstico de base al momento de la consulta por la lesión cribiforme en piel, demostrando así que el PG puede ser el primer hallazgo de una enfermedad inflamatoria intestinal, sugiriendo descartar condición de base ante dicha presentación, al igual que el trabajo realizado por Shahid et al (8). En cuanto a la histopatología, los hallazgos no son específicos, pero la biopsia es necesaria para excluir otras causas de ulceración como causas infecciosas, cancer o condiciones vasculíticas (tabla 3) (1,5).…”

Atypical Pyoderma gangrenosum: a case of delayed recognition

“…[9]. Consideration of PG is not only important in the presence of known underlying systemic disease but can also be the initial presenting manifestation and so should always be on the differential in any patient [12]. Table 1. A lack of established guidelines makes treatment of PG challenging as there are few clinical trials in the literature.…”

MRI features of pyoderma gangrenosum in a diabetic patient with ulcerative colitis: A case report and review of the literature

“…In the setting of a known ulcer and soft tissue swelling, both clinical presentations of PG, MRI can also be useful to assess the presence of cellulitis, fluid collections or nodular lesions. MRI can determine the degree and extension of cellulitis which will present as skin thickening and increased signal intensity within the subcutaneous soft tissue on fluid sensitive sequences [8] , assess the presence, morphology, size and location of a fluid collection and determine the presence of nodular subcutaneous lesions [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] .…”

“…Although it can affect both sex and any age group, it is more common among the young and middle-aged population (30-60 years) with a predilection for females [4] .…”