Atypical Forms of Pyoderma Gangrenosum in Inflammatory Bowel Disease: Report of Four Cases and Literature Review

• Published in: International medical case reports journal Vol. 15; pp. 449 - 456
• Main Authors: Martinelli, Valéria Ferreira, Martinelli Barbosa, Pedro, Dantas de Oliveira, Lucila Samara, Melo, Luísa de Andrade Lima Vieira de, Casa Nova, João Manoel, Brito, Carlos Alexandre Antunes de
• Format: Journal Article
• Language: English
• Published: Macclesfield Dove Medical Press Limited 31-08-2022; Taylor & Francis Ltd; Dove; Dove Medical Press
• Subjects: Adalimumab; Arthritis; Azathioprine; Case reports; Case Series; Colitis; Comorbidity; Corticosteroids; Crohns disease; crohn’s disease; Edema; Erythema; extraintestinal manifestations; Health aspects; Immunotherapy; Inflammatory bowel disease; Inflammatory diseases; Literature reviews; Patients; Pyoderma; pyoderma gangrenosum; Remission (Medicine); Skin; Tumor necrosis factor-TNF; ulcerative colitis; Ulcers; Womens health; Brazil
• ISSN: 1179-142X; 1179-142X
• DOI: 10.2147/IMCRJ.S376915

Background: Cutaneous involvement is the second-most frequent extraintestinal manifestation of inflammatory bowel disease, with pyoderma gangrenosum (PG) a particularly relevant form because of its frequency, morbidity, and recurrence. The limited number of clinical trials involving PG increases the challenge to gastroenterologists in the management of this condition. Case Presentation: Four cases of atypical presentations of PG are reported. A 25-year-old patient with ulcerative colitis presented an extensive chronic ulcerative lesion on her left leg that was associated with significant bleeding; the intestinal disease was in remission under the use of azathioprine. The patient was on long-term use of 60 mg corticosteroid with no improvement in the skin disease; however, initiation of cyclosporine induced remission. In the second case, a 52-year-old woman was a carrier of Crohn's disease, with a history of partial colectomy. The patient's skin condition had evolved with a cutaneous lesion localized in the perineal region, buttocks, and colostomy pouch, simulating a case of impetigo, and this had been treated with antibiotic cycles without improvement. Lesion biopsy suggested a diagnosis of PG. Consequently, the patient was started on biological therapy with infliximab, and the PG regressed. In the third case, a 38-year-old woman with a history of pancolitis presented a picture of PG with an extensive and deep ulcerative lesion in the right breast. The lesion regressed after treatment with oral corticosteroid. His final case was a 44-year-old woman with Crohn's disease suffering from Crohn's disease pancolitis. The patient's condition evolved with a mixed pattern with pustules, bullae, and ulcerative lesions in the vulva, oral cavity, gluteus, right auricular region, scalp, and left flank, and was resolved by administration of adalimumab. Conclusion: PG is an important and frequent manifestation of inflammatory bowel disease, with a spectrum of clinical variants, significant morbidity, and requiring a variety of therapeutic approaches. Keywords: inflammatory bowel disease, pyoderma gangrenosum, Crohn's disease, ulcerative colitis, extraintestinal manifestations