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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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(a) Photomicrography of lesional skin biopsy from ulcer margin showing necrotic epidermis with intense neutrophilic infiltrate and fibrin deposition, H and E × 10X. (b) Photomicrography of a lesional skin biopsy from flaccid vesicle showing suprabasal acantholysis with tomb stone arrangement of basal keratinocytes, H and E × 40X
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Figure 2: (a) Photomicrography of lesional skin biopsy from ulcer margin showing necrotic epidermis with intense neutrophilic infiltrate and fibrin deposition, H and E × 10X. (b) Photomicrography of a lesional skin biopsy from flaccid vesicle showing suprabasal acantholysis with tomb stone arrangement of basal keratinocytes, H and E × 40X

Mentions: A skin biopsy from the ulcer margin showed necrotic epidermis with intense neutrophilic infiltrate, capillary proliferation and fibrin deposition [Figure 2a]. A biopsy from the edge of the bulla showed suprabasal acantholysis with tomb stone appearance of basal cells [Figure 2b]. 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. Hematological and biochemical parameters were within normal limits. Serological analysis for anti-nuclear antibody and rheumatoid factor were negative. 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. The cutaneous lesions of PV disappeared within a week and the ulcer showed signs of healing. Oral steroids were tapered in 4 months and the cutaneous lesion healed with scarring. After a follow-up duration of 8 months the patient continues to be in remission with no other systemic abnormalities.


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

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

(a) Photomicrography of lesional skin biopsy from ulcer margin showing necrotic epidermis with intense neutrophilic infiltrate and fibrin deposition, H and E × 10X. (b) Photomicrography of a lesional skin biopsy from flaccid vesicle showing suprabasal acantholysis with tomb stone arrangement of basal keratinocytes, H and E × 40X
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: (a) Photomicrography of lesional skin biopsy from ulcer margin showing necrotic epidermis with intense neutrophilic infiltrate and fibrin deposition, H and E × 10X. (b) Photomicrography of a lesional skin biopsy from flaccid vesicle showing suprabasal acantholysis with tomb stone arrangement of basal keratinocytes, H and E × 40X
Mentions: A skin biopsy from the ulcer margin showed necrotic epidermis with intense neutrophilic infiltrate, capillary proliferation and fibrin deposition [Figure 2a]. A biopsy from the edge of the bulla showed suprabasal acantholysis with tomb stone appearance of basal cells [Figure 2b]. 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. Hematological and biochemical parameters were within normal limits. Serological analysis for anti-nuclear antibody and rheumatoid factor were negative. 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. The cutaneous lesions of PV disappeared within a week and the ulcer showed signs of healing. Oral steroids were tapered in 4 months and the cutaneous lesion healed with scarring. After a follow-up duration of 8 months the patient continues to be in remission with no other systemic abnormalities.

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