Concomitant Pyoderma Gangrenosum-like and Amicrobial Pustulosis of the Folds: a Case Report
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LETTER TO EDITOR
Concomitant Pyoderma Gangrenosum-like and Amicrobial Pustulosis of the Folds: a Case Report Paola Facheris 1,2 & Maria De Santis 3 & Luigi Gargiulo 1,2 & Giulia Pavia 1,2 & Mario Valenti 1,2 & Sofia Manara 4 & Riccardo G. Borroni 1,2 & Antonio Costanzo 1,2 & Alessandra Narcisi 1 Received: 19 March 2020 / Accepted: 30 June 2020 # The Author(s) 2020
Introduction To the Editor, The skin is one of the most commonly affected organs by the extraintestinal manifestations of inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC). UC may present cutaneous manifestation in 5% to 11% of patients [1]. Based on their pathophysiology, cutaneous manifestations associated with IBD can be classified in 4 categories as follows: specific, reactive, associated, and induced by IBD treatment [1]. Reactive cutaneous manifestations have a different histopathology but have close physiopathologic link with the intestinal disease, being autoinflammatory skin diseases such as neutrophilic dermatoses.
Case Presentation An 18-year-old patient presented to our dermatologic outpatient clinic for the appearance of an ulcer on the lateral side of her right ankle. Her past medical history was notable for spondylarthritis and ulcerative colitis since the age of 12, previously treated with two TNF-alfa inhibitors (infliximab and adalimumab). At the time of our evaluation, the patient was * Paola Facheris [email protected] 1
Department of Dermatology, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089 Rozzano, MI, Italy
2
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
3
Department of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center-IRCCS, Rozzano, MI, Italy
4
Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, MI, Italy
under treatment with low doses of systemic steroids following a recent exacerbation of the intestinal disease. The cutaneous lesion had been already evaluated elsewhere a week before the presentation at our department and a cultural exam resulted completely sterile. However, the patient complained of a progressive worsening of the ulcer. On physical examination, there was the presence of a 5-cm tender ulcer exhibiting violaceous and undermined borders with a purulent base. Intense erythema was noted around the borders of the ulcers. In order to exclude the suspect of osteomyelitis, a CT scan and an MRI of the left foot and leg were performed. Both exams gave negative results concerning osteomyelitis or abscess formation but highlighted a significant involvement of the subcutaneous tissue. Also, numerous pustules were noted at the inguinal folds bilaterally and the patient referred similar episodes in the past treated as folliculitis with topical antibiotic therapy. The patient was admitted for further evaluation and during hospitalization other lesions appeared as follows: pustules were present on the left thigh, right thigh, and left gluteus. In a few hou
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