Question
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
Show Answer
Correct Answer ยป C
Explanation
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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:
- Ulcerative colitis
- Crohn’s disease
Arthritides:
- Rheumatoid arthritis
- Seronegative arthritis
Hematological disease:
- Myelocytic leukemia
- Hairy cell leukemia
- Myelofibrosis
- Myeloid metaplasia
- 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.
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