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Devi B, Mohanty J. Pyoderma gangrenosum. Indian J Dermatol Venereol Leprol 2003;69:193
AbstractFour patients aged 8, 35, 45 and 50 years (3 males and 1 female) were admitted to SCBMCH, Cuttack, skin and VD Department with multiple, painful, non healing phagadenic ulcers over body and not responding to the conventional therapeutic agents. The female patient was having severe seropositive rheumatoid arthritis.
Pus culture was negative in all the cases. All the patients responded well to corticosteroid given systemically, but one male patient was having recurring episodes and ulcers healing hardly. He was given topical oxoferrin (TCDO) topically twice daily along with other supportive therapy. He responded well.
Pyoderma gangrenosum is a rare disease characterized by chronic, recurrent ulceration of non-infective origin and usually associated with ulcerative colitis, rheumatoid arthritis, regional ileitis and several other hematological disorders. PG. is a circumscribed necrotizing vasculitis of unknown etiology. It chiefly affects persons 40-60 years, but childhood PG. has also been described. The first case of PG. was described by Brunsting et al, in 1930.
Four cases aged 8, 35, 40 and 50 (3M, IF) were admitted to Skin & V.D Department S.C.B. Medical College, Cuttack from 1995-96. They presented with multiple non-healing ulcers and did not respond to antibiotics. Besides routine investigations like haemogram, fasting blood sugar, stool examination, urinalysis, special investigations like VDRL, pus culture and sensitivity test, rheumatoid factor, serum proteins, liver function tests, thorough G.I investigations like colonoscopy and rectal biopsy were done. Histopathological study was done in all cases to confirm the diagnosis.
The child and the young male developed the lesions for the first time at the age 8 and 35 years at sites of trauma inflicted by injection. This explains well the phenomenon of "pathergy" associated with 40% cases of PG. Arnold6 described in a teenage boy every acne pustule and needle puncture becoming a circular spreading ulcer. The young male did not have any underlying inflammatory bowel disease.
The elderly woman (50 years) had seropositive rheumatoid arthritis which is a usual association with PG. The male (45 years) who presented with vesicular lesions of PG, underlying malignancy was searched for because it may be the usual presentation of leukemia or hematological disorder.
The young male (35 years) was admitted thrice to our ward. Besides lesions on legs, arms and scrotum he had ulcers over the neck and inside the mouth which are manifestations of malignant PG. Histopathology was consistent with PG, characterised by neutrophilic infiltrate in the dermis and extending into epidermis.
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