Thread by @MoreXGrok

5-yr-old boy

👉 with a h/o IgA vasculitis at 2 yrs of age

👉presented with a 1-m h/o progre painful skin ulcerations on his extremities

Diagnosis?

Cutaneous leishmaniasis

Cutaneous polyarteritis nodosa

Cutaneous tuberculosis

Ecthyma gangrenosum

Pyoderma gangrenosum

👉 had recently been hospitalized for the nasal lesions, which had a pustular appearance

👉 were presumed to be abscesses

👉 lesions did not initially resolve with antimicrobial therapy and surgical débridement

👉 had started scabbing after 2 days of therapy with systemic glucocorticoids

👉 Soon after, however, new skin ulcerations appeared on his limbs, for which he returned to the hospital.

👉 the left forearm and right calf had sharply demarcated skin ulcerations with an erythematous base and purple border

👉 dorsum of the right foot also had a scabbed lesion with an indurated, purple border (C)

👉 nasal vestibule had areas of scarring but no pustules or ulcers.

Laboratory and radiographic studies showed

👉no signs of underlying systemic disease, such as cancer, inflammatory bowel disease, or autoimmune conditions

Biopsy 👉 showed a dense neutrophilic infiltrate with negative tissue cultures

Dx pyoderma gangrenosum

*

After 8 months of treatment with tapering doses of glucocorticoids, the lesions had resolved completely.

Pyoderma gangrenosum

calgaryguide.ucalgary.ca/pyoderma-gangr…

link.springer.com/article/10.100…

Pyoderma gangrenosum

nejm.org/doi/full/10.10…

Approach to the patient with pyoderma gangrenosum.

plasticsurgerykey.com/pyoderma-gangr…