Pyoderma gangrenosum with renal and splenic impairment - case report

Abstract

Pyoderma gangrenosum is an uncommon and recurrent neutrophilic dermatosis of unknown cause. The lesions usually start as tender sterile papulopustules or erythematous nodules that undergo necrosis followed by ulceration. The lower limbs are most commonly affected and around half of the cases are associated with systemic disorders. Although rare, cases of pyoderma gangrenosum with extramucocutaneous sterile neutrophilic infiltrate have been reported, with the lungs being the most commonly affected organ. We report a case of pyoderma gangrenosum with splenic and renal impairment. Pyoderma gangrenosum should be considered a multisystemic disease with classic cutaneous manifestations and potential involvement of internal organs.

Pyoderma gangrenosum with spleen involvement. Review of the literature and case report.

“…From the 10 reviewed cases, 3, including the reported case, were completely asymptomatic, 6,8 one presented only with splenomegaly without symptoms, 9 one presented fever and splenomegaly, 3 one fever and malaise, 10 3 patients presented fever with abdominal pain 4,5,7 and one presented fever, abdominal pain and splenomegaly. 11 Our patient had cutaneous manifestations before the diagnosis of splenic involvement was made and splenic lesions were asymptomatic. The presence of splenic abscesses was an incidental finding on the abdominal US which was prescribed in order to rule out an underlying disorder, and was confirmed by abdominal CT scan.…”

“…Aditional articles were identified using the reference lists of the identified papers. We have found nine reported cases [3][4][5][6][7][8][9][10][11] ; the clinical information of the cases including ours is summarized in Table 1.…”

Pyoderma gangrenosum with spleen involvement. Review of the literature and case report.

“…Fine needle aspiration, performed in 3 cases 4,7,11 revealed purulent fluid, but cultures for aerobic and anaerobic bacteria, fungi and mycobacteria were negative. Histopathologic assessment was performed in 3 cases, 3,8,9 but the findings were not specific, the main finding being predominant neutrophil infiltration, similar to those observed in skin biopsy specimens.…”

“…16 Three of the reviewed cases of PG with splenic involvement responded well to corticosteroids alone; 3,8,9 in other three cases corticosteroids associated with cyclosporine led to a good response; 4,5,6 in one case sulfasalazine was added to corticosteroids and cyclosporine. 11 Two of the reviewed cases were nonresponsive to corticosteroids and other suppressive agents. 7,10 Infliximab was tried, with good response in one of the cases; 7 unfortunately the patient developed an allergic reaction to the product, precluding further infusions; subcutaneous Etanercept was of no benefit over a 3-week period and hence Adalimumab was commenced with great improvement.…”

Pyoderma gangrenosum—a systemic disease?

“…18,19 Splenic and renal involvement of PG is extremely rare. 20,21 Genital involvement has been reported in both men and women, where cervical involvement may resemble cellulitis. 22 More often, nonspecific ulcerations have been reported on penile and vulvar skin and mucous membranes.…”