Superficial Granulomatous Pyoderma: A Case in an 11-Year-Old Girl and Review of the Literature

Tollefson, Megha M.; Cook-Norris, Robert H.; Theos, Amy; Davis, Dawn M.

doi:10.1111/j.1525-1470.2010.01271.x

Cited by 11 publications

(22 citation statements)

References 19 publications

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“…8 Pulmonary involvement is rare in children with classic PG (seven cases reported) 9 and has not been reported in children with SGPG. 2,3,[5][6][7] In our patient, one of the differential diagnoses was granulomatosis with polyangiitis (GPA). Lung disease develops in most individuals with GPA, varying from asymptomatic lung nodules to fulminant alveolar hemorrhage, 10 and cutaneous PG-like ulcerations 11 and nodular scleritis (NS) have been reported in several individuals.…”

Section: Discussionmentioning

confidence: 85%

“…Only six previous cases of pediatric SGPG have been reported. Clinical features, histologic findings, and response to treatment are shown in Table …”

Section: Discussionmentioning

confidence: 96%

“…Clinical features, histologic findings, and response to treatment are shown in Table 1. 2,3,[5][6][7] Classic PG mainly affects the skin, although extracutaneous involvement has been reported to occur in the lungs, liver, spleen, bones, heart, eye, and meninges. 8 Pulmonary involvement is rare in children with classic PG (seven cases reported) 9 and has not been reported in children with SGPG.…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary nodules and nodular scleritis in a teenager with superficial granulomatous pyoderma gangrenosum

Contreras-Verduzco

Espinosa‐Padilla²,

Orozco‐Covarrubias³

et al. 2017

Pediatric Dermatology

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Superficial granulomatous pyoderma gangrenosum, a rare variant of pyoderma gangrenosum, has been considered to be the most benign form of the disease. We present the case of a 15-year-old boy with pulmonary involvement and nodular scleritis associated with this unusual type of pyoderma gangrenosum and discuss its differential diagnosis. | CASE REPORTA 15-year-old boy presented with a pustular, warty eruption of 4 months duration. Cutaneous lesions involving the scalp, trunk, limbs, and genitals were characterized by numerous pustules surrounded by an erythematous halo and vegetative and keratotic plaques with crusts and purulent discharge overlying ulcerated, slightly painful plaques ( Figure 1A,B). Ocular examination showed erythema, conjunctival injection, and scleral nodules (Figure 2A). Several 2-to 3-mm pustules were seen on the hard palate. He also had marked digital clubbing and cyanosis ( Figure 2B), despite pulmonary auscultation with no remarkable findings, absence of dyspnea, and pulse oximetry of 92%.The patient's disease had started 9 months before with cough and he was treated for chronic bronchitis, with partial improvement.Five months before the onset of the dermatosis, he was empirically treated for pulmonary tuberculosis, but the cough persisted.During examination, a pathergy test was negative, and chest Xrays revealed a reticulonodular pattern and probable bronchiectases.Computed tomography (CT) showed pleural fibrosis, the vascular pattern was more apparent, and noncavitated nodules. Paranasal sinus CT was normal. Lung function tests showed a mild restrictive pattern. Bronchoscopy revealed mild tracheoendobronchitis with a diffuse nodular pattern. Tests were negative for microorganisms. Pulmonary hypertension was excluded. Complete blood cell count showed leukocytosis (12 9 10 3 /mm) with neutrophilia (77%). Erythrocyte sedimentation rate (22 mm/h) and C-reactive protein

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Section: Discussionmentioning

confidence: 85%

“…Only six previous cases of pediatric SGPG have been reported. Clinical features, histologic findings, and response to treatment are shown in Table …”

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pulmonary nodules and nodular scleritis in a teenager with superficial granulomatous pyoderma gangrenosum

Contreras-Verduzco

Espinosa‐Padilla²,

Orozco‐Covarrubias³

et al. 2017

Pediatric Dermatology

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show abstract

“…It is essential that the evaluation includes a biopsy with tissue cultures. Although SGPG is generally unaccompanied by an additional underlying systemic disorder, the possibility of an occult process such as inflammatory bowel disease or blood dyscrasia (including paraproteinemia) cannot be entirely discounted, and a workup should be performed as clinically indicated . Treatment with tetracycline‐class antibiotics, dapsone, topical or intralesional corticosteroids , or topical tacrolimus may suffice to heal these lesions, as they are considered to be relatively more responsive to therapy.…”

Section: Inflammatory Ulcersmentioning

confidence: 99%

Atypical ulcers

Hoffman

2013

Dermatol Ther

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Atypical ulcers of the skin challenge the dermatologist with respect to recognition, diagnosis, management, and treatment. The entire gamut of pathogenic categories including vascular, inflammatory, neoplastic, genetic, medication-related, and infectious processes may give rise to atypical ulcers. By definition, these ulcers are unusual, and accurate diagnosis may ultimately require the clinician to violate the dictum that "common things are common." Atypical ulcers may present with features that the clinician has not previously encountered, or may present with seemingly typical features that actually mislead due to phenotypic mimicry. Because skin ulcers are inherently tissue-destructive, and may reflect an underlying systemic disease process, there is heightened urgency to achieving an accurate diagnosis and initiating appropriate therapy.

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“…Successful SGP therapy includes conservative treatment with antibacterial or local anti-inflammatory and immunosuppressive agents. Facial SGP involvement is particularly rare and tends to be more refractory to topical management (7).…”

Section: Facial Superficial Granulomatous Pyodermamentioning

confidence: 99%