A case report of atypical presentation of pyoderma gangrenosum with ulcerative colitis: successful treatment with prednisolone and mesalazine therapy
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Introduction. Pyoderma gangrenosum (PG) manifests as recurrent deep ulceration of the skin and PG is often associated with a variety of systemic diseases, such as inflammatory bowel disease (IBD), rheumatoid arthritis, paraproteinaemia, hematologic malignancies and hepatitis. Ap - proximately 30% of the cases of PG develop in patients with inflammatory bowel disease. There has been neither laboratory finding nor histological feature diagnostic of PG, and diagnosis of PG is mainly made based on the exclusion criteria. Patient and methods. We report here a male patient 21 years old, complained of rectal bleeding of 3 weeks duration. He presented with a large, painful and rapidly progressive cutaneous ulcer in the right flank. Laboratory and microbiological investigations, colonoscopic biopsy and a skin biopsy from the ulcer were performed. Results. An atypical presentation of PG with ulcerative colitis (UC) was diagnosed. The PG rapidly resolved after beginning of prednisolone and mesalazine therapy and the ulcer healed with scar. After successful treatment the patient suddenly stopped all his treatment and he came back again with rectal bleeding and a rounded, painful and rapidly progressive cutaneous ulcer in each cheek. One month after starting prednisolone and mesalazine treatment, complete healing of both ulcers with scars has occurred. Conclusion. A rare atypical presentation of PG with risk of misdiagnosis and the unusual rapid healing of PG with combination of prednisolone and mesalazine therapy were concluded.
KEY WORDS: pyoderma gangrenosum; ulcerative colitis; prednisolone; mesalazine.