Pyoderma Gangrenosum with an Unusual Syndrome of Ulcers, Vesicles, and Arthritis

Pyoderma gangrenosum in Immunosuppressed Patients

“…In most cases it has been related to an autoimmune process such as ulcerative colitis [2,3] and various forms of arthritis [4,5], The disease was considered by some to be a localized Shwartzman phenomenon [6,7] and others assumed it to be a hyperergic reaction against bacterial lipopolysaccharides [8], Long and Uesu [9] observed, in 2 patients with the disease, rejection of an autoskin and a delayed hypersensitivity to intradermal injection of the patients own leukocytes. Changes similar to those seen in acute reaction to skin graft rejection have been observed on biopsy and indirect immunofluorescence study [10] and were reported to be characteristic features in a review of 117 cases with the process [4], On the other hand, Lazarus et al [11] demonstrated an anergic-delayed hypersensitivity reaction in 4 patients with pyoderma gangrenosum and also reported a dissociation between macro phage inhibitory factor production and the blastogénie response, which may indicate a partial defect in cellular immunity.…”

Two Cases of Pyoderma (Ecthyma) Gangraenosum Associated with the Presence of an Abnormal Serumprotein (β₂A-paraprotein)

“…The last group, of 54 patients, had no intestinal disorders [22,66,37,18,51,19,23,46,21,72,44,35,33,25,47,74,67,43,65,55,1,53,58,28,5,36,50,57,69,63,41,31,62,29], I. (a) The association o f pyoderma gangraenosum and arthritis in the patients with colitis ulcerosa.…”

“…In this group of 54 cases 6 patients are mentioned as having swell ings of the big joints [43,55,1,53,50, 69] and 9 as suffering from " arthritis" [66,25,55,1,58,41,62]. Finally one patient is described as having an arthrosis of the spine.…”

“…(c) In the group of 54 patients w ithout intestinal symptom s, sim ul taneous exacerbation of arthritis and pyoderma is only mentioned in two patients [66,1].…”

“…Ayres and Ayres [1] followed in 1958, reporting two patients, both having arthritis. Sulfapyridin cleared the patients of their ulcers and vesiculous eruption, one of them relapsed when therapy was dis continued.…”