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Images in Dermatology
December 15, 2021

Pyoderma Gangrenosum

Author Affiliations
  • 1Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
JAMA Dermatol. 2022;158(2):202. doi:10.1001/jamadermatol.2021.5001

A 24-year-old woman with Crohn disease developed painful ulcers with rapid deterioration on the left lower leg for 1 month along with intermittent fever and chills. She recalled a minor trauma on the left lower leg 1 month prior that occurred during a motor vehicle collision. It began as a painful coin-sized ulcerative wound and grew to have rapid clinical progression, expansion, and subsequent development of new lesions.

Physical examination showed 2 large ulcerative plaques with ill-defined, violaceous, and undermined borders with cribriform scarring (Figure). Laboratory examination results showed mild leukocytosis (10 700 /uL; reference range, 3500-11 000 /uL) and elevated C-reactive protein levels (11.86 mg/dL [to convert to mg/L, multiply by 10]; reference range, <0.5 mg/dL). Antinuclear antibody, rheumatoid factor, and antineutrophil cytoplasmic antibody levels were within normal limits. Histopathological examination demonstrated a diffuse neutrophilic infiltrate accompanied by a few lymphocytes and eosinophils. There was no growth of bacteria, fungi, or mycobacteria from tissue cultures, leading to the diagnosis of pyoderma gangrenosum. The patient was treated with systemic prednisone, 20 mg, twice a day; azathioprine, 25 mg, daily; cyclosporine, 100 mg, daily; and mesalamine, 2000 mg, twice a day, for 3 months and experienced complete healing of skin lesions.

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