Pyoderma Gangrenosum with Subcutaneous Abscesses

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  • Hori Enmi
    Department of Dermatology, Medical Sciences for Control of Pathological Processes, Graduate School of Comprehensive Human Sciences, University of Tsukuba
  • Furuta Junichi
    Department of Dermatology, Medical Sciences for Control of Pathological Processes, Graduate School of Comprehensive Human Sciences, University of Tsukuba
  • Maruyama Hiroshi
    Department of Dermatology, Medical Sciences for Control of Pathological Processes, Graduate School of Comprehensive Human Sciences, University of Tsukuba
  • Ito Shusaku
    Department of Dermatology, Medical Sciences for Control of Pathological Processes, Graduate School of Comprehensive Human Sciences, University of Tsukuba
  • Ishii Yoshiyuki
    Department of Dermatology, Medical Sciences for Control of Pathological Processes, Graduate School of Comprehensive Human Sciences, University of Tsukuba
  • Takahashi Takenori
    Department of Dermatology, Medical Sciences for Control of Pathological Processes, Graduate School of Comprehensive Human Sciences, University of Tsukuba
  • Otsuka Fujio
    Department of Dermatology, Medical Sciences for Control of Pathological Processes, Graduate School of Comprehensive Human Sciences, University of Tsukuba

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Other Title
  • 皮下膿瘍を伴った壊疽性膿皮症
  • ヒカ ノウヨウ オ トモナッタ エソセイ ノウ ヒショウ

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Abstract

We report a 22-year-old male with pyoderma gangrenosum (PG) and ulcerative colitis (UC)．He was diagnosed with UC at the age of 18 and treated with oral corticosteroid. Two months before his initial visit, the UC had recurred, and oral corticosteroid was restarted. About one month later, a painful reddish swelling appeared in his right foot. Repeated debridement and antibiotics were ineffective. The swelling later transformed into an ulcer with pus and yellowish necrotic tissue. Frequent bacteriological cultures were negative. Two weeks later, subcutaneous fluid collections with redness and tenderness appeared on his chest and both shins. Yellowish syrupy pus was drained from his right shin by debridement. He was admitted in our hospital for further treatment. Computer tomography of the legs revealed lens-shaped fluid accumulation above the fasciae. He was diagnosed with PG based on his clinical appearance, complication with UC, and absence of microorganisms. Increasing the dose of oral corticosteroids from 20 to 60 mg per day healed the skin ulcer and subcutaneous abscesses and resulted in the remission of the UC. PG along with cellulitis and subsequent subcutaneous abscess is rare, and it should be distinguished from infectious diseases by careful observation of clinical features, bacteriological studies, and imaging.

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