Image Based Question-72061

A patient suffering from Ulcerative Colitis preseted with the following skin condition. Histopathological examination showed massive neutrophilic infiltration.What can be the most possible diagnosis?

A. Acute febrile neutrophilic dermatosis

B. Wegener Granulomatosis

C. Pyoderma Gangrenosum

D. Tuberculosis gumma

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Correct Answer » C Explanation

Ans:C. Pyoderma Gangrenosum.

Pyoderma gangrenosum

• It is a rare, neutrophilic dermatosis, commonly associated with systemic disease. The typical presentation is a painful ulcer (or ulcers) that grows rapidly and develops an irregular, undermined, purple edge..Pyoderma gangrenosum ulcers demonstrate pathergy, that is, a worsening in response to minor trauma or surgical debridement.

Associations:

Inflammatory bowel disease:

1. Ulcerative colitis
2. Crohn’s disease

Arthritides:

1. Rheumatoid arthritis
2. Seronegative arthritis

Hematological disease:

1. Myelocytic leukemia
2. Hairy cell leukemia
3. Myelofibrosis
4. Myeloid metaplasia
5. Monoclonal gammopathy

Autoinflammatory disease:

• Pyogenic sterile arthritis, pyoderma gangrenosum, and acne syndrome (PAPA syndrome)
• Granulomatosis with polyangiitis

Diagnosis:

• Often a diagnosis of exclusion, skin biopsy shows a massive neutrophilic infiltration, hemorrhage, and necrosis of the overlying epidermis.

Treatment:

• First-line therapy for disseminated or localized instances of pyoderma gangrenosum is systemic treatment by corticosteroids and ciclosporin. Topical application of clobetasol, mupirocin, and gentamicin alternated with tacrolimus can be effective.

• If ineffective, alternative therapeutic procedures include systemic treatment with corticosteroids and mycophenolate mofetil; mycophenolate mofetil and ciclosporin; tacrolimus; thalidomide; infliximab; or plasmapheresis.