Abstract:

Pyoderma gangrenosum is a rare neutrophilic noninfec­tious dermatose. Etiopathogenesis remains unclear, but in half of cases, there is an associated underlying dis­ease. Inflammatory bowel disease is the most common underlying disorder. Systemic immunosuppressive or im­munomodulator drugs and some topical agents are used in treatment of pyoderma gangrenosum. Systemic corti­costeroids are the first-choice of treatment. We reported a case with Crohn\'s disease associated with pyoderma gangrenosum. She was successfully treated with oral methyl prednisolon. The case was a 54-year-old woman who admitted to hospital because of erythematous, pain­ful plaques on the right and left pretibial surfaces. She had a history of Crohn\'s disease, diabetes mellitus, and hypertension. An elevated white blood cell count (13500/μL) and high erythrocyte sedimentation rate (120 mm/h) were detected. A regime of broad-spectrum antibiotics was started, but response was poor. Histopathological assessment of biopsy specimens showed necrosis, se­vere edema and erythrocyte extravasations in superficial dermis, regenerative changes in adjacent epithelium, and mixed inflammatory reaction surrounding necrosis in the inner part of the dermis. Based on these clinical and labo­ratory findings, poor response to antibiotics and underly­ing disease; her skin lesions were considered as pyoder­ma gangrenosum. Oral methylprednisolone was started and her skin lesions improved. The steroid dose was ta­pered and finally stopped under outpatient follow-up. In conclusion, our patient also showed that corticosteroids continue to be the first-choice therapy in pyoderma gan­grenosum.

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