Pyoderma gangrenosum and necrotizing arteritis in elderly onset rheumatoid arthritis – a case study
Authors:
Hrnčíř Zb 1; L. Sobotka 2; M. Pospíšil 2; P. Prášil 3; J. Brtková 4; J. Laco 5
Authors‘ workplace:
II. interní gastroenterologická klinika, 2III. interní gerontometabolická klinika, 3Klinika infekčních nemocí, 4Radiologická klinika, 5Fingerlandův ústav patologie, Lékařská fakulta Univerzity Karlovy a Fakultní nemocnice, Hradec Králové
1
Published in:
Čes. Revmatol., 26, 2018, No. 2, p. 59-63.
Overview
Pyoderma gangrenosum (PG) is a rare disorder from the group of neutrophilic dermatoses, partly as a serious comorbidity in rheumatoid arthritis. The main form of its clinical manifestation is abacterial necrotizing skin ulceration (-s) with irregular, indurative and violaceous border (espec. trunk/LE). The present study demonstrates a serious form of PG in a 73y old man; the last form of PG composite diagnostic criteria (2017) was completely fulfilled, and the observation was also associated with the following important aspects: (a) clinical manifestation of PG and elderly onset (ACPA and RFs isotypes seropositive) rheumatoid arthritis (EORA) were parallel, (b) PG ulceration was present as a masquerading phenomenon of fibrinoid-necrotic (rheumatoid) arteritis, and (c) the response to long-term glucocorticoid-cyclosporine combination was slow, but up to the presence persistent. Observation of the triade „pyoderma gangrenosum – rheumatoid arthritis – necrotizing arteritis“ may be consider as an inspirative combination both in complicated pathways, and also as an important clinical problem.
Key words:
Elderly onset rheumatoid arthritis, pyoderma gangrenosum, pathergic reaction, necrotizing arteritis, glucocorticoids, cyclosporine
Sources
1. Farhi D. The clinical and histopathological description of geometric phagedenism (pyoderma gangrenosum) by Louis Brocq: one century ago. Arch Dermatol 2008; 144: 755.
2. Gaimero A, Pereira N, Cardoso JC, Goncalo M. Pyoderma gangrenosum: challenges and solutions. Clinical, Cosmetic and Investigational Dermatology 2015; 8: 285–293.
3. Moinzadeh P, Krieg Th. Neutrophilic dermatoses. In: Watts RA et al. (eds). Oxford Textbook of Rheumatology. 4th ed., Oxford: Oxford Univ. Press:2013. p. 1426–1433.
4. Langan SM, Groves RW, Card TR, Gulliford MC. Incidence, mortality, and disease assotiations of pyoderma gangrenosum in the United Kingdom: A retrospective cohort study. J Invest Dermatol 2012; 132: 2166–2170.
5. Hau E, Vignon Pennamen MD, Battistella M, Saussine A, Bergis M, Calevelier-Balloy B et al. Neutrophilic skin lesions in autoimmune connective tissue diseases. Medicine 2014; 93: e346.
6. Zuo KJ, Fung E, Tredget EE, Lin An. A systematic review of post-surgical pyoderma gangrenosum: identification of risk factors and proposed management strategy. J Plast Reconstr Aesthet Surg 2015; 68: 295–303.
7. Simon A, van der Meer JWS, Drenth JPH. Familiar autoinflammatory syndromes. In: Firestein GS et al. (eds). Kelley´s Textbook of Rheumatology. 9th ed. Philadelphia: Elsevier; 2013, p.1597–1615.
8. Navarini AA, Satoh TK, French LE. Neutrophilic dermatoses and autoinflammatory diseases with skin involvement – innate immune disorders. Semin Immunopathol 2016; 38: 45–56.
9. Marzano AV, Borghi A, Wallach D, Cugno M. A comprehensive review of neutrophilic diseases. Clinic Rev Allerg Immunol.2017; 54: 114–130.
10. Gade M, Studsgtrup F, Andersen AK, Hilberg O, Fogh C, Bendstrup E. Pulmonary manifestations of pyoderma gangrenosum: 2 cases and a review of the literature. Respiratory Med 2015; 109: 443–450.
11. Be M, Cha HJ, Park Ch, Park Y, Jung H, Lee Y et al. Multiple pulmonary cavitary nodules with pyoderma gangrenosum in patients with rheumatoid arthritis. Ann Trans Med 2016; 4: 39–42.
12. Brooklyn TN, Dunnill MGS, Shetty A, Bowden JJ, Williams JDL Grittiths CEM et al. Infliximab for the treatment of pyoderma gangrenosum: a randomised, double blind, placebo-controlled trial. Gut 2005; 55: 505–509.
13. Hviščová K, Pavelka K. Kožní manifestace revmatoidní artritidy. Čes Revmatol 2010: 18: 125–131.
14. Akahoshi-Ikeda M, Youshizawa S, Motoshita J, Furue M, Takeuchi S. A case of pyoderma gangrenosus in a patient with rheumatoid arthritis treated with Abatacept. Acta Derm Venerol 2016; 96: 822–823.
15. Devi B, Mohanty J. Pyoderma gangrenosum. Indian J Dermatol Venerol Leprol 2003; 69: 193.
16. Das SK, Banerjee N, Khaskil S, Mukkherjee SS. Pyoderma gangrenosum and high titter serum anti-CCP2 antibodies. J Nepal Med Assoc 2012; 52: 36–39.
17. Su WP, Davis MD, Weenig RH, Powel HO. Pyoderma gangrenosum: clinicopathologic correlation and proposed diagnostic criteria. Int J Dermatol 2004; 43: 790–800.
18. Loetscher J, Fistarol S, Walker UA. Pyoderma gangrenosum and erythema nodosum revealing Takayasu´s arteritis. Case Rep Dermatol 2016; 8: 354–357.
19. Gastman B, Hashem AM, Djohan R, Bernard S, Hendrickson M, Schwarz G et al. Malignant pyoderma associated with granulomatosis with polyangiitis (Wegener granulomatosis) as a unique indication for facial vascularized composite allotransplantation. Plastic Reconstructive Surgery 2016; 37: 632–635.
20. De Cambourg G, Mahé A, Banea S, Moulinas C, Blaison G. Granulomatosis with polyangiitis revealed by a cutaneous ulceration mimicking a pyoderma gangrenosum: Two patients. Rev Med Intern 2016; 37: 632–635
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Dermatology & STDs Paediatric rheumatology RheumatologyArticle was published in
Czech Rheumatology
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