Pyoderma gangrenosum in hematologic malignancies: A systematic review

Montagnon, Carmen M.; Fracica, Elizabeth; Patel, Archna A.; Camilleri, Michael; Murad, M. Hassan; Dingli, David; Wetter, David A.; Tolkachjov, Stanislav N.

doi:10.1016/j.jaad.2019.09.032

Cited by 45 publications

(36 citation statements)

References 246 publications

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“…Besides corticosteroids, immunosuppressive medications like cyclosporine can also be used to treat PG but have limited applicability when it comes to already immunocompromised patients like ours and are, therefore, reserved for resistant cases. It is important to discuss the possible differential diagnoses of the disease to distinguish it better (Table 2 ) and to understand the rare incidence of PG in hematological malignancies (Table 3 ) [ 4 - 6 ].…”

Section: Discussionmentioning

confidence: 99%

Necrotizing Cellulitis and Myositis in a Neutropenic Leukemic Patient

Alok¹,

Greene²

2021

Cureus

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In this article, we review a case of necrotizing cellulitis and myositis in a neutropenic leukemic patient. He underwent a series of investigations to reach the diagnosis of pyoderma gangrenosum (PG). The lesion improved dramatically after pertinent identification and initiation of appropriate treatment. The management of PG is exceedingly challenging due to a lack of proper clinical criteria for detection and guidelines for treatment. PG must be considered as a differential in patients with enlarging, sterile, necrotic lesions, unresponsive to prolonged broad-spectrum antibiotics. Prompt recognition can prevent deeper infections and the formation of a chronic open wound causing cosmetic disfigurement along with other catastrophic complications.

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Section: Discussionmentioning

confidence: 99%

Necrotizing Cellulitis and Myositis in a Neutropenic Leukemic Patient

Alok¹,

Greene²

2021

Cureus

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“…Haematological malignancies associated with PG, which are a major cause of death in this disease [ 41 , 67 ], are mainly represented by acute and chronic myeloid leukaemia [ 68 , 69 ], myelodysplastic syndrome [ 70 ], multiple myeloma [ 71 ], monoclonal gammopathy of undetermined significance [ 72 ] and lymphoma [ 73 ]. Although IgG isotype gammopathies are overall more frequent, most monoclonal gammopathies associated with PG are of the IgA isotype [ 47 , 74 ].…”

Section: Neutrophilic Dermatosesmentioning

confidence: 99%

“…In a recent systematic review of 340 cases of HM-associated PG [ 74 ], the most frequently observed neoplasm was myelodysplastic syndrome ( n = 83; 24.4%), followed by monoclonal gammopathy of undetermined significance ( n = 75; 22.1%) and acute myeloid leukaemia ( n = 39; 11.5%). In the same systematic review, classic (ulcerative) PG was the most common presentation, while the bullous variant represented the most frequent form observed in the subgroup with acute myeloid leukaemia [ 74 ].…”

Section: Neutrophilic Dermatosesmentioning

confidence: 99%

“…This is in contrast to the findings of Bennett et al, who concluded in a study of 86 patients that haematological diseases or malignancies were associated with BP more frequently than with classic PG [ 75 ]. The systematic review by Montagnon et al [ 74 ] showed also that the diagnosis of HMs preceded the onset of PG in most cases and that most patients with available data (75%) achieved PG control with systemic corticosteroids, while chemotherapy alone led to healing of PG in only 7.5% of cases. Cyclosporine and TNF-α inhibitors are not recommended in patients with HM-associated PG [ 41 ].…”

Section: Neutrophilic Dermatosesmentioning

confidence: 99%

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Immune-Mediated Dermatoses in Patients with Haematological Malignancies: A Comprehensive Review

et al. 2020

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Haematological malignancies induce important alterations of the immune system, which account for the high frequency of autoimmune complications observed in patients. Cutaneous immune-mediated diseases associated with haematological malignancies encompass a heterogeneous group of dermatoses, including, among others, neutrophilic and eosinophilic dermatoses, autoantibody-mediated skin diseases, vasculitis and granulomatous dermatoses. Some of these diseases, such as paraneoplastic pemphigus, are associated with an increased risk of death; others, such as eosinophilic dermatoses of haematological malignancies, run a benign clinical course but portend a significant negative impairment on a patient's quality of life. In rare cases, the skin eruption reflects immunological alterations associated with an unfavourable prognosis of the associated haematological disorder. Therapeutic management of immune-mediated skin diseases in patients with haematological malignancies is often challenging. Systemic corticosteroids and immunosuppressive drugs are considered frontline therapies but may considerably augment the risk of serious infections. Indeed, developing a specific targeted therapeutic approach is of crucial importance for this particularly fragile patient population. This review provides an up-to-date overview on the immune-mediated skin diseases most frequently encountered by patients with onco-haematological disorders, discussing new pathogenic advances and therapeutic options on the horizon.

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“…PG has been found to be associated with hematologic disorders, including IgA monoclonal gammopathy, polycythemia vera, myelodysplastic syndrome, acute myeloid leukemia, chronic myeloid leukemia, and hairy cell leukemia. 4 B. IgG kappa monoclonal gammopathy e Correct. NXG is associated with paraproteinemia, most commonly IgG monoclonal gammopathy (65%).…”

Section: Bmentioning

confidence: 99%

Ulcerating yellow plaques on the legs

et al. 2021

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A woman in her sixties with a 25-year history of multiple myeloma presented with yellow-orange plaques on her lower extremities. The plaques waxed and waned for years without associated pain or pruritus, but recently they became painful and ulcerated, thus prompting evaluation by dermatology (Figs 1 and 2). Treatments previously administered for multiple myeloma, including corticosteroids, stem cell transplantation, immunotherapy, and chemotherapy, had variable effects on the lesions. Treatment for multiple myeloma had been suspended because her disease was stable and there was concern that the skin progression could represent an adverse effect. An incisional biopsy for histologic examination was performed, with representative sections shown (Fig 3).

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Pyoderma gangrenosum in hematologic malignancies: A systematic review

Cited by 45 publications

References 246 publications

Necrotizing Cellulitis and Myositis in a Neutropenic Leukemic Patient

Necrotizing Cellulitis and Myositis in a Neutropenic Leukemic Patient

Immune-Mediated Dermatoses in Patients with Haematological Malignancies: A Comprehensive Review

Ulcerating yellow plaques on the legs

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