Pyoderma Gangrenosum With Inflamatory Bowel Disease

Abstract

Pyoderma gangrenosum (PG) is a chronic, painful ulcerated skin disease of unknown etiology. Its association with inflammatory bowel disease like ulcerative colitis is common. The lesions generally appear during the course of active bowel disease, frequently concur with exacerbations of colitis, sometimes with inactive ulcerative colitis. 15 to 20 % of patients with Pyoderma gangrenosum have ulcerative colitis and 0.5 to 5 % of patients with ulcerative colitis have Pyoderma gangrenosum. occasionally skin lesions may preceed active inflammation of colon. Here we report a case of 50 year old female presenting with large ulcerated lesion over the anterior aspect of the middle 1/3 rd of left leg associated with severe pain and bloody discharge. skin biopsy shows epidermis with necrosis and diffuse dense neutrophilic infiltrate in superficial epidermis extending into the deep dermis. Colonoscopy shows features of ulcerative colitis. Patient showed rapid response with systemic steroids and specific treatment with 5-amino salicylic acid (mesalamine). ulcer healed within 6 weeks and followed for 3months with no recurrence.