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| http://dx.doi.org/10.1016/j.jdcr.2021.01.011 | DOI Listing |
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A 31-year-old female, recently discharged after improvement of an exacerbation of ulcerative colitis, returned to the hospital due to fever, polyarthralgia affecting the knees and ankles, and symmetric violaceous papulopustular lesions on her arms, trunk, and lower limbs. Histological examination revealed superficial dermal edema and perivascular invasion of neutrophils with leukocytoclasia, consistent with neutrophilic dermatosis, and a diagnosis of bowel-associated dermatosis-arthritis syndrome (BADAS) was established. BADAS is a rare, characteristic neutrophilic dermatosis and arthritis mainly associated with intestinal inflammatory disease due to bacterial overgrowthand subsequent immune complex formation and deposition.
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Department of Dermatology, Philippine General Hospital, University of the Philippines Manila.
Pyoderma gangrenosum (PG) is a chronic inflammatory neutrophilic dermatosis often presenting as a solitary enlarging painful ulcer with red to violaceous undermined borders. This report delves into the role of doxycycline in the treatment of PG in a 44-year-old male COVID-19 positive patient who has concomitant active tuberculosis infection and end-stage kidney disease, for which both first-line treatments (systemic corticosteroid and cyclosporine) are contraindicated. After three months on doxycycline and topical corticosteroids, there was resolution of the ulcers and no note of recurrence up to three months from completion of the treatment regimen.
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Pyoderma gangrenosum is a rare neutrophilic dermatosis that presents as a tender, rapidly progressive ulcer with violaceous, undermined borders. Pathophysiology is multifactorial and has been suggested to involve neutrophil dysfunction, increased T-cell activation, and inflammatory mediator release, often in settings that are known to have autoimmune or genetic diseases. Some medications that modify the immune response have been described to trigger pyoderma gangrenosum.
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Article Synopsis
- - Pyoderma gangrenosum (PG) is a rare condition that causes painful ulcers, which can occur after trauma like needle insertion, a phenomenon known as pathergy; this report highlights a 69-year-old woman who developed PG after hemodialysis.
- - The patient experienced painful ulcers at the site of needle insertion on her arteriovenous fistula (AVF), prompting a diagnosis of PG following a thorough evaluation that ruled out other causes.
- - Treatment involved suspending dialysis through the AVF and using medications such as prednisone, topical corticosteroids, and colchicine to manage PG; her condition improved, allowing for safe resumption of dialysis while minimizing the risk of further complications.
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