Pyoderma Gangrenosum in a Pregnant Patient. Case Report
Authors:
A. Bártlová 1; M. Salavec 1
Authors‘ workplace:
Klinika nemocí kožních a pohlavních, Fakultní nemocnice a Lékařská fakulta v Hradci Králové, přednosta doc. MUDr. Miloslav Salavec, CSc.
Published in:
Čes-slov Derm, 95, 2020, No. 6, p. 212-217
Category:
Case Reports
Overview
The authors present a case of a 34-year-old pregnant patient with confirmed diagnosis of pyoderma gangrenosum (PG). As systemic corticosteroid therapy had not resulted in lesion clearing, combined immunosupressive treatment (corticosteroids, cyclosporine A and mycophenolate mofetil) was administered that led to gradual healing of the lesions. Steroid and gestational diabetes developed as complications of therapy. Furthermore, ulcerative colitis was diagnosed year and a half after the appearance of skin lesions. The administration of infliximab led to remission of PG as well as ulcerative colitis and enabled the discontinuation of previous combined immosuppresive treatment. The article reviews recent knowledge of diagnostics and therapeutical approaches in this disease.
Keywords:
pyoderma gangrenosum – ulcerative dermatosis – pregnancy – combined immunosuppressive therapy – biologic therapy
Sources
1. BALATAZAR, D., HAAG, C., GUSTA, A. S. et al. Comprehensive Review of Local Pharmacologic Therapy for Pyoderma Gangrenosum. Wounds, 2019 Jun;31(6). p. 151–157.
2. BATALLA, A., PÉREZ-PEDROSA, A., GARCÍA-DOVAL, I. et al. Lung involvement in pyoderma gangrenosum: a case report and review of the literature. Actas Dermosifiliogr, 2011 Jun;102 (5), p. 373–377.
3. BRAHIMI, N., MAUBEC, E., BOCCARA, O. et al. Pyoderma gangrenosum with aseptic spleen abscess. Ann Dermatol Venereol., 2009 Jan;136 (1), p. 46–49.
4. BOLOGNA, J. L., SCHAEFFER, J. V., DUNCAN, K. O. et al. Dermatology Essentials. Elsevier 2014; p. 202–205. ISBN 978-1-4557-0841-3.
5. FEJEROVÁ, M. Pyoderma gangrenosum. www. https://zezdravotnictvi.cz/profi-medicina/pyoderma-gangrenosum/, 2019.
6. GADE, M., STUDSTRUP, F., ANDERSEN, A. K. et al. Pulmonary manifestations of pyoderma gangrenosum: 2 cases and a review of the literature. Respir Med., 2015 Apr;109 (4), p. 443–4450. doi: 10.1016/j.rmed.2014.12.016. Epub 2015 Jan 14.
7. HERCOGOVÁ, J. et al. Klinická dermatovenerologie. 1. díl, Praha: Mladá fronta 2019, p. 229–232. ISBN 978-80-204-5321-1.
8. HOHENLEUTNER, U., MOHR, V. D., MICHEL, S., LANDTHALER, M. Mycophenolate mofetil and cyclosporin treatment for recalcitrant pyoderma gangrenosum. Lancet, 1997 Dec 13;350(9093), p. 1748.
9. CHATZIKONSTANTINOU, M., KONSTANTOPOULOS, M., STERGIOPOULOS, S. et al. Calprotectin as a diagnostic tool for inflammatory bowel diseases. Biomed Rep., 2016 Oct; 5(4), p. 403–407.
10. JACKSON, J. M. Pyoderma gangrenosum. Updated Mar 09, 2020, https://emedicine.medscape.com/article/1123821-overview.
11. JARČUŠKOVÁ, D., BENEČOVÁ, K., FICOVÁ, M. et al. Pyoderma gangraenosum – klinické aspekty, léčba. Čes-slov Derm, 2002, No. 2, p. 80–83.
12. MAVERAKIS, E., MA, CH., SHINKAI, K. et al. Diagnostic Criteria of Ulcerative Pyoderma Gangrenosum. A Delphi Consensus of International Experts. JAMA Dermatol., 2018, 154 (4), p. 461–466.
13. MISEROCCHI, E., MODORATI, G., FOSTER, C. S. et al. Ocular and Extracutaneous Involvement in Pyoderma Gangrenosum. Ophtalmology, 2002 Oct, 109(10):1 p. 941–943.
14. MOKHTARIFAR, A., GANJI, A., SADRNESHIN, M. et al. Diagnostic Value of ASCA and Atypical p-ANCA in Differential Diagnosis of Inflammatory Bowel Disease. Middle East J Dig Dis., 2013 Apr, 5 (2), p. 93–97.
15. NAVRÁTILOVÁ, Z., SEMRÁDOVÁ, V. Pyoderma gangraenosum – možnosti terapie. Čes-slov Derm., 2000, No. 5, p. 238–240.
16. QUIST, S. R., KRAAS, L. Treatment options for pyoderma gangrenosum. JDDG, Volume15, Issue 1, January 2017, p. 34–40.
17. PETRÁŠOVÁ, D. Pyoderma gangrenosum. Dermatologie pro praxi, 2013, 7(3), p. 134–135.
18. SAVIGE, J., DAVIES, D., FALK, R. J. et al. Antineutrophil cytoplasmic antibodies and associated diseases: A review of the clinical and laboratory features. Perspectives in Renal Medicine, Volume 57, ISSUE 3, p. 846–862.
19. STIEGLER, J. D., LUCAS C. T., SAMI, N. Pyoderma gangrenosum in pregnancy successfully treated with infliximab and prednisone. JAAD Case Rep., 2017, Sep, 3 (5), p. 387–389.
20. SULLIVAN, M. G. Attack Pyoderma Gangrenosum with an Array of Treatment Options. Dermatology News, https://www.mdedge.com/dermatology/article/17917/wounds/attack-pyoderma-gangrenosum-ar-ray-treatment-options.
21. ŠTORK, J. et al. Dermatovenerologie. 2. vyd. Praha: Galén, 2013, p. 320–321, ISBN 978-80-7262-898-8.
22. TERJUNG, B., HERZOG, V., WORMA, W. J. et al. Antineutrophil Cytoplasmic Antibodies With Perinuclear Fluorescence in Chronic Inflammatory Bowel Diseases and Hepatobiliary Disorders Colocalize with Nuclear Lamina Proteins. Hepatology, 1998 Aug, 28 (2), p. 332–340. https://pubmed.ncbi.nlm.nih.gov/?term=%22Hepatology%22%5Bjour%5Dhttps://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Hepatology%22%5bTitle+Abbreviation%5dhttps://pubmed.ncbi.nlm.nih.gov/9695994/.
Labels
Dermatology & STDs Paediatric dermatology & STDsArticle was published in
Czech-Slovak Dermatology
2020 Issue 6
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