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Granulomatous pyoderma gangrenosum of the genitalia in the absence of Crohn's disease.

Kambil SM, Bhat RM, Dandekeri S - Indian J Sex Transm Dis (2015 Jan-Jun)

Bottom Line: Atypical variants of PG such as vegetative PG, bullous PG, and pustular forms are described in literature.Occasionally, granulomatous reaction in dermis may be seen on histology when PG is associated with Crohn's disease or in the vegetative variant of PG.We report a case of granulomatous PG involving the genitalia in a 43-year-old female without associated inflammatory bowel disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Father Muller Medical College, Kankanady, Mangalore, Karnataka, India.

ABSTRACT
Pyoderma gangrenosum (PG) is a rare ulcerative neutrophilic disorder of the skin. Atypical variants of PG such as vegetative PG, bullous PG, and pustular forms are described in literature. Occasionally, granulomatous reaction in dermis may be seen on histology when PG is associated with Crohn's disease or in the vegetative variant of PG. We report a case of granulomatous PG involving the genitalia in a 43-year-old female without associated inflammatory bowel disease.

No MeSH data available.


Related in: MedlinePlus

Healed ulcer at 1 month follow-up
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Figure 4: Healed ulcer at 1 month follow-up

Mentions: A 43-year-old female presented with a painful solitary ulcer on the genitalia of 1-year duration. The lesion started as a pustule which ruptured and formed the ulcer. There was no history of fever, joint pain, oral ulcers, abdominal pain, loose stool, preceding trauma, or weight loss. Her general physical and systemic examination was normal. Cutaneous examination revealed a single ulcer of 3 cm × 4 cm size with hyperpigmented irregular margins and slightly undermined edges located on the lower part of mons pubis extending to the upper part of vulva [Figure 1]. The ulcer was slightly tender, nonindurated, and floor was covered with red granulation. There was no regional lymphadenopathy. The differential diagnoses considered were PG, tuberculous ulcer, deep fungal infection, donovanosis, and Crohn's disease. Findings of routine blood workup, peripheral smear, urine analysis, stool examination, chest X-ray and colonoscopy were normal. Mantoux test, antineutrophil cytoplasmic antibody, HIV testing, and Venereal Disease Research Laboratory were negative. Tissue smear for Donovan bodies was negative. At the site of venepuncture, patient developed an indurated plaque of 1 cm × 2 cm which was suggestive of pathergy phenomenon [Figure 2]. Gram-stain and culture and sensitivity done from the floor of the ulcer showed gram negative bacilli sensitive to gentamicin. Smear for acid-fast bacilli (AFB) done from the floor of the ulcer was negative. Histopathology showed infiltration of neutrophils, lymphocytes, and plasma cells in the dermis with occasional ill-defined granulomas and giant cells. Special stains for AFB and fungus were negative [Figure 3a and b]. Patient was given gentamicin for 3 weeks without much improvement. Based on clinical and histopathological features, a final diagnosis of the granulomatous variant of PG was made, and patient was given prednisolone 30 mg/day. At 1 month follow-up, ulcer had completely healed with mild scarring [Figure 4]. Treatment was stopped after 1 month, and there was no recurrence.


Granulomatous pyoderma gangrenosum of the genitalia in the absence of Crohn's disease.

Kambil SM, Bhat RM, Dandekeri S - Indian J Sex Transm Dis (2015 Jan-Jun)

Healed ulcer at 1 month follow-up
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4555903&req=5

Figure 4: Healed ulcer at 1 month follow-up
Mentions: A 43-year-old female presented with a painful solitary ulcer on the genitalia of 1-year duration. The lesion started as a pustule which ruptured and formed the ulcer. There was no history of fever, joint pain, oral ulcers, abdominal pain, loose stool, preceding trauma, or weight loss. Her general physical and systemic examination was normal. Cutaneous examination revealed a single ulcer of 3 cm × 4 cm size with hyperpigmented irregular margins and slightly undermined edges located on the lower part of mons pubis extending to the upper part of vulva [Figure 1]. The ulcer was slightly tender, nonindurated, and floor was covered with red granulation. There was no regional lymphadenopathy. The differential diagnoses considered were PG, tuberculous ulcer, deep fungal infection, donovanosis, and Crohn's disease. Findings of routine blood workup, peripheral smear, urine analysis, stool examination, chest X-ray and colonoscopy were normal. Mantoux test, antineutrophil cytoplasmic antibody, HIV testing, and Venereal Disease Research Laboratory were negative. Tissue smear for Donovan bodies was negative. At the site of venepuncture, patient developed an indurated plaque of 1 cm × 2 cm which was suggestive of pathergy phenomenon [Figure 2]. Gram-stain and culture and sensitivity done from the floor of the ulcer showed gram negative bacilli sensitive to gentamicin. Smear for acid-fast bacilli (AFB) done from the floor of the ulcer was negative. Histopathology showed infiltration of neutrophils, lymphocytes, and plasma cells in the dermis with occasional ill-defined granulomas and giant cells. Special stains for AFB and fungus were negative [Figure 3a and b]. Patient was given gentamicin for 3 weeks without much improvement. Based on clinical and histopathological features, a final diagnosis of the granulomatous variant of PG was made, and patient was given prednisolone 30 mg/day. At 1 month follow-up, ulcer had completely healed with mild scarring [Figure 4]. Treatment was stopped after 1 month, and there was no recurrence.

Bottom Line: Atypical variants of PG such as vegetative PG, bullous PG, and pustular forms are described in literature.Occasionally, granulomatous reaction in dermis may be seen on histology when PG is associated with Crohn's disease or in the vegetative variant of PG.We report a case of granulomatous PG involving the genitalia in a 43-year-old female without associated inflammatory bowel disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Father Muller Medical College, Kankanady, Mangalore, Karnataka, India.

ABSTRACT
Pyoderma gangrenosum (PG) is a rare ulcerative neutrophilic disorder of the skin. Atypical variants of PG such as vegetative PG, bullous PG, and pustular forms are described in literature. Occasionally, granulomatous reaction in dermis may be seen on histology when PG is associated with Crohn's disease or in the vegetative variant of PG. We report a case of granulomatous PG involving the genitalia in a 43-year-old female without associated inflammatory bowel disease.

No MeSH data available.


Related in: MedlinePlus