Generic selectors
Exact matches only
Search in title
Search in content
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology

Translate this page into:

Case Report
2001:67:5;259-260
PMID: 17664767

Pyoderma gangrenosum and urinary tract infection

A Chopra, A Jha, D Chopra
 Department of Dermato-Venereology, Raiendra Hospital, Patiala - 147 001, India

Correspondence Address:
A Chopra
27, Bank Colony, Patiala - 147 001
India
How to cite this article:
Chopra A, Jha A, Chopra D. Pyoderma gangrenosum and urinary tract infection. Indian J Dermatol Venereol Leprol 2001;67:259-260
Copyright: (C)2001 Indian Journal of Dermatology, Venereology, and Leprology

Abstract

A case of pyoderma gangrenosum is reported in a 52 - year - old man who had skin lesions without any association. On investigation urinary tract infection was detected. Treatment of UTI led to spontaneous healing of the lesions in short period thus avoiding the need of oral corticosteroids.
Keywords: Pyoderma gangrenosum

Introduction

Pyoderma gangrenosum is a destructive, necrotizing, non - infective ulceration of skin, presenting as a furuncle - like nodule, pustule or haemorrhagic bulla.[1] Histopathologically it falls within spectrum of neutrophilic dermatoses.[2] A variety of systemic diseases are associated but in 10-30% of cases it occurs as an isolated cutaneous phenomenon.[3] Here we report a case where the patient was initially diagnosed as an isolated case of pyoderma gangrenosum (PG), but investigations revealed urinary tract infection thus proving the association of PG secondary to hidden focus of infection.

Case Report

A 52 - year - old male patient presented with one ulcerated skin lesion which started as a vesiculopustule on left hand, of one month duration and one lesion each, on right hand and right cheek of 15 days duration. The lesions were painless and non- pruritic. There was no history of fever, joint pain, constipation, diarrhoea, malena or burning micturition. History of extramarital contact was absent.

On examination, the lesion, on dorsum of left index finger, was an ulcerated plaque 6 x 3 cm [Figure - 1] with ragged and udermined edge, erythematous and bluish tinged margin and necrotic base. The lesion

on dorsolateral aspect of right hand [Figure - 1] was a noduloplaque 3 x 3 cm with crusting and ulceration, and one on right cheek was a 1 cm folliculo nodular lesion with superficial ulceration.

Laboratory investigations showed Hb-13.5 gm%, normal peripheral blood film, TLC - 8400/mm3, DLC-N-61%, L-33%, E-5%, B-1%, ESR-30 mm/first hr, FBS -105mg%, SGOT - 14 IU/L, and SGPT - 161U/ L. Urine examination showed 9-10 pus cells/HPF;2-4 RBCs, culture examination showed E.coli sensitive to norfloxacin. Consecutive 3 stool tests, and chest X-ray were normal. Mantoux test was negative.

Clinically, diagnosis of pyoderma gangrenosum was made. A wedge biopsy was taken from the bigger lesion. The patient was put on treatment for UTI with norfloxacin 400mg BD for 5 days. Institution of steroid was deferred in view of biopsy report and patient was called for follow up after 5 days.

Meanwhile, histopathological report showed the following:--

The epidermis showed acanthosis, hyperkeratosis and necrosis at places with predominance of degenerated neutrophils. The deeper dermis showed mononuclear cells with lymphocytes and plasma cells. Fibrinoid deposits and thrombi were seen in the vessel wall. The dermal papillae showed numerous extravasated RBCs and small areas of haemorrhage. All the findings were consistent with our diagnosis of PG.

Re-examination of the patient after five days showed dramatic improvement. The lesion on face and right hand had healed with mild scarring whereas the size of lesion on left hand had decreased in size and showed no signs of activity.

Discussion

Pyoderma gangrenosum has been described in association with ulcerative colitis, Crohn′s disease, rheumatoid arthritis, monoclonal gammopathies, myeloproliferative diseases, post traumatic infectious diseases, diabetes etc.[3] In 10 - 30% of cases it occurs as an isolated cutaneous phenomenon. In our case PG was clinically diagnosed as an isolated cutaneous phenomenon without any association. Our investigations revealed asymptomatic UTI. The temporal correlation of healing of the lesions with treatment of UTI confirms the association of PG with UTI. The dramatic improvement in short time, as in our case, is unlikely without corticosteroid or treatment of the cause. A careful examination and complete investigation should be done in all cases of PG and if any hidden focus of infection is present, as in our case, a full course of antibiotics should be administered. This will lead to reduction in the number of isolated cases of PG and unnecessary administration of corticosteroids can also be avoided.

References
1.
Perry HO, Winkelmann RK. Bullous pyoderma gangrenosum and leukaemia. Arch Dermatol 1972 ; 106 : 901 - 905.
[Google Scholar]
2.
Callen JP. Cutaneous vasculitis : Relationship to systemic disease and therapy. Curr Probl Dermatol 1993 ; 5 : 45.
[Google Scholar]
3.
Rook, Wilkinson, Ebling. Pyoderma gangrenosum. Textbook of Dermatology. Vol 3; 6th edition : 2186.
[Google Scholar]
Show Sections