Pyoderma gangrenosum of the eyelid and acute rhinosinusitis

Abstract

Pyoderma gangrenosum (PG) is a destructive, necrotizing, noninfective ulceration of the skin. Periorbital PG is extremely rare, and may progress, with eventual loss of the eye. We report a 47-year-old woman who presented with a right periorbital swelling of 8 days duration and concurrent acute rhinosinusitis. A clinical diagnosis of right periorbital PG was made, and treatment instituted with intravenous methylprednisolone and antibiotics, resulting in rapid resolution of the condition. The clinical features in this case, together with the past history of histologically confirmed PG, enabled a rapid diagnosis to be made, with early administration of treatment resulting in minimal scarring. The clinical picture could easily be confused with periorbital cellulitis, and this case demonstrates the importance of considering the differential diagnoses of periorbital swelling.

Systemic pyoderma gangrenosum responding to infliximab and adalimumab

“…Ocular involvement, as episcleritis or scleral ulcers, 4 has been rarely reported, as has inflammation in the periorbital tissues and sinuses. 5 Splenic abscesses have been described in two patients prior to this case. 3 Only one previous report describes a myositis in association with PG.…”

“…The central nervous system has been involved in two cases of PG, in one as a pituitary mass and in one as aseptic meningitis. Ocular involvement, as episcleritis or scleral ulcers, 4 has been rarely reported, as has inflammation in the periorbital tissues and sinuses 5 . Splenic abscesses have been described in two patients prior to this case 3 .…”

“…In addition, he had acute episodes when he became extremely unwell, requiring urgent readmission. These episodes were characterized by high fevers, neutrophilia of up to 45 · 10 9 L )1 (normal 2-7AE5 · 10 9 ), and grossly elevated C-reactive protein (270 mg L )1 ; normal < 8) and erythrocyte sedimentation rate (150 mm in the first hour; normal [1][2][3][4][5][6][7][8][9][10][11][12][13]. Multiple blood cultures on each occasion were negative.…”

Pyoderma Gangrenosum of the Eyelid: Report of Two Cases and Review of the Literature

“…Here, we report 2 cases with PG of the eyelid and review well-documented reports from the literature [2,3,4,5,6,7,8,9,10,11]. We summarise the clinical information of the 15 PG cases of the eyelid including the present 2 patients in table 1.…”

Pyoderma gangrenosum of the eyelid

“…Only 15 other cases have been reported, and they have a wide range of clinical presentations, treatments, and outcomes. [4][5][6][7][8][9][10][11][12][13][14] Our case is instructive for its dramatic response to oral steroids and for highlighting clinical features that may be predictive of a good outcome.…”