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Pyoderma gangrenosum in a patient with pemphigus vulgaris: an unusual association.

Keshavamurthy V, Kanwar AJ, Saikia UN - Indian J Dermatol (2015 Jan-Feb)

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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A 27-year-old female patient of oral PV for 8 months presented with complains of rapidly progressive, painful ulcer over the left thigh and a few flaccid vesicles as well as bullae over the trunk and proximal lower extremities since 1 week... A skin biopsy from the ulcer margin showed necrotic epidermis with intense neutrophilic infiltrate, capillary proliferation and fibrin deposition [Figure 2a]... Direct immunofluorescence (DIF) from perilesional skin showed intercellular deposits of IgG and C3... Bacterial, fungal and mycobacterial culture of the pus did not show any organism growth... Based on these features a diagnosis of PG in a patient of mucocutaneous PV was made... The patient was started on oral prednisolone 80 mg per day and azathioprine 100 mg/day was continued... Su et al. have proposed diagnostic criteria for diagnosis of PG and our patient fulfilled two major and three minor criteria... On extensively reviewing the literature, we found no previous report of coexistence of PG and PV... It is well established that IL-8, a neutrophilic chemoattractant, is an important cytokine in the pathogenesis of PG... The role of IL-8 in PV is controversial... However, Keskin et al. in an 18 month prospective study of 10 patients found that there was a significant reduction in the level of IL-8 following treatment in comparison to baseline values... It is possible that in our patient acute flare of PV (transformation of mucosal PV to mucocutaneous PV) was associated with an elevated level of IL-8, contributing to the pathogenesis of PG... In conclusion, we report a previously undescribed association of PG with PV.

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Related in: MedlinePlus

(a) Clinical photography showing a large necrotic ulcer, with purulent base and surrounding erythema over the anterolateral aspect of left thigh. A flaccid bulla can also be appreciated below the ulcer (arrow). (b) Clinical photography showing gingival erosions
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Figure 1: (a) Clinical photography showing a large necrotic ulcer, with purulent base and surrounding erythema over the anterolateral aspect of left thigh. A flaccid bulla can also be appreciated below the ulcer (arrow). (b) Clinical photography showing gingival erosions

Mentions: A 27-year-old female patient of oral PV for 8 months presented with complains of rapidly progressive, painful ulcer over the left thigh and a few flaccid vesicles as well as bullae over the trunk and proximal lower extremities since 1 week. The ulcer started as a painful erythematous nodule, which soon ruptured to form a necrotic ulcer with copious purulent discharge. Her current treatment included oral prednisolone 10 mg/day and azathioprine 100 mg/day. On examination, a deep necrotic ulcer of size 4×6 cm was noted over the anterolateral aspect of left thigh [Figure 1a]. The ulcer was exquisitely tender and had a necrotic purulent base with surrounding erythema and semi-adherent greenish brown crust. Surrounding the ulcer and over the trunk were 8-10 flaccid blisters containing clear fluid [Figure 1a]. Nikolsky's sign was positive. Oral mucosal examination revealed erosions involving the gingival margins and buccal mucosa [Figure 1b].


Pyoderma gangrenosum in a patient with pemphigus vulgaris: an unusual association.

Keshavamurthy V, Kanwar AJ, Saikia UN - Indian J Dermatol (2015 Jan-Feb)

(a) Clinical photography showing a large necrotic ulcer, with purulent base and surrounding erythema over the anterolateral aspect of left thigh. A flaccid bulla can also be appreciated below the ulcer (arrow). (b) Clinical photography showing gingival erosions
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4318051&req=5

Figure 1: (a) Clinical photography showing a large necrotic ulcer, with purulent base and surrounding erythema over the anterolateral aspect of left thigh. A flaccid bulla can also be appreciated below the ulcer (arrow). (b) Clinical photography showing gingival erosions
Mentions: A 27-year-old female patient of oral PV for 8 months presented with complains of rapidly progressive, painful ulcer over the left thigh and a few flaccid vesicles as well as bullae over the trunk and proximal lower extremities since 1 week. The ulcer started as a painful erythematous nodule, which soon ruptured to form a necrotic ulcer with copious purulent discharge. Her current treatment included oral prednisolone 10 mg/day and azathioprine 100 mg/day. On examination, a deep necrotic ulcer of size 4×6 cm was noted over the anterolateral aspect of left thigh [Figure 1a]. The ulcer was exquisitely tender and had a necrotic purulent base with surrounding erythema and semi-adherent greenish brown crust. Surrounding the ulcer and over the trunk were 8-10 flaccid blisters containing clear fluid [Figure 1a]. Nikolsky's sign was positive. Oral mucosal examination revealed erosions involving the gingival margins and buccal mucosa [Figure 1b].

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A 27-year-old female patient of oral PV for 8 months presented with complains of rapidly progressive, painful ulcer over the left thigh and a few flaccid vesicles as well as bullae over the trunk and proximal lower extremities since 1 week... A skin biopsy from the ulcer margin showed necrotic epidermis with intense neutrophilic infiltrate, capillary proliferation and fibrin deposition [Figure 2a]... Direct immunofluorescence (DIF) from perilesional skin showed intercellular deposits of IgG and C3... Bacterial, fungal and mycobacterial culture of the pus did not show any organism growth... Based on these features a diagnosis of PG in a patient of mucocutaneous PV was made... The patient was started on oral prednisolone 80 mg per day and azathioprine 100 mg/day was continued... Su et al. have proposed diagnostic criteria for diagnosis of PG and our patient fulfilled two major and three minor criteria... On extensively reviewing the literature, we found no previous report of coexistence of PG and PV... It is well established that IL-8, a neutrophilic chemoattractant, is an important cytokine in the pathogenesis of PG... The role of IL-8 in PV is controversial... However, Keskin et al. in an 18 month prospective study of 10 patients found that there was a significant reduction in the level of IL-8 following treatment in comparison to baseline values... It is possible that in our patient acute flare of PV (transformation of mucosal PV to mucocutaneous PV) was associated with an elevated level of IL-8, contributing to the pathogenesis of PG... In conclusion, we report a previously undescribed association of PG with PV.

No MeSH data available.


Related in: MedlinePlus