Case presentation: Pyoderma Gangrenosum associated with two internal disorder, hypothyroidism and Rheumatoid arthritis.

Author: Dr.Bhavesh Devani MD

            Drashti Skin and Eye Care Hospital- Morbi (Gujarat)

Abstract

INTRODUCTION:

            Pyoderma gangrenosum (PG) is an uncommon ulcerative cutaneous condition of uncertain etiology. Pyoderma gangrenosum was first described in 1930. It is associated with systemic diseases in at least 50% of patients who are affected. The diagnosis is made by excluding other causes of similar appearing cutaneous ulcerations, including infection, malignancy, vasculitis, collagen vascular diseases, diabetes, and trauma. Ulcerations of pyoderma gangrenosum may occur after trauma or injury to the skin in 30% of patients; this process is termed pathergy.

            A female patient aged 40 years presented with ulcer on left calf about 15X10 cm in size with yellowish exudates and undermined edge with violaceous border. Ulcer was painful ,margin of ulcer are inflamed with adherent slough. She is having same big ulcer over posteromedial aspect of  left thigh 20X15 cm in size before 2 years leaving atrophic scar.HP examination disclosed focal ulceration with mixed inflammatory cells. Infiltration predominantly composed of neutrophils.

            Her ulcer is associated with systemic disorder of Rheumatoid Arthritis and Hypothyrodism.Patient treated with systemic antibiotic according to pus culture sensitivity report, systemic steroids and anti inflammatory drugs.

            Because of rare disease and associated with two autoimmune disorder this typical case of pyoderma gangrenosum  is presented.

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