ABSTRACT
La histoplasmosis diseminada es una infección oportunista frecuente en los pacientes VIH/sida. Frecuentemente se encuentra compromiso cutáneo, siendo las formas clínicas más comunes el aspecto moluscoide, variceliforme y papulonecrótico.Se presenta el caso de una paciente con una forma cutánea atípica de histoplasmosis diseminada similar a pioderma gangrenoso cuyo diagnóstico fue realizado mediante escarificación.Es importante mantener la sospecha clínica en estas presentaciones atípicas y reforzar la utilidad de la escarificación de lesiones cutáneas como método rápido y efectivo para su diagnóstico.
Disseminated histoplasmosis is a frequent opportunistic infection in HIV/AIDS patients. Cutaneous manifestations are common, the most frequent are molluscum contagio-sum-like lesions, varicelliform eruption and papulo-necro-tic lesions.We present a case of an atypical disseminated cutaneous histoplasmosis with pyoderma gangrenosum-like ulcers, diagnosed by direct examination of tissue smear.It is important to have a high clinical suspicion of this atypical presentation and to emphasize the usefulness of skin smear as a simple and effective test to establish its diagnosis
Subject(s)
Humans , Female , Adult , Skin Ulcer , Opportunistic Infections/complications , HIV/immunology , Pyoderma Gangrenosum/diagnosis , Histoplasmosis/diagnosisABSTRACT
El pioderma gangrenoso ampollar es una variedad infrecuente de pioderma gangrenoso, que se asocia en el 50-70% de los casos con trastornos oncohematológicos. Se comunica el caso de una paciente de 59 años, que consultó por fiebre y ampollas purpúricas de rápida progresión, con compromiso cutáneo mucoso. Con sospecha de una enfermedad neutrofílica, ampollar, o infección por gérmenes oportunistas, se realizó biopsia de piel para estudio histopatológico, inmunofluorescencia directa y cultivo. Los cultivos y la inmunofluorescencia directa fueron negativos, y la anatomía patológica reveló un denso infiltrado inflamatorio con predominio neutrofílico en dermis. Ante el diagnóstico de pioderma gangrenoso ampollar, se realizó una punción-aspiración de médula ósea cuyo resultado fue compatible con leucemia mieloide aguda. Se instauró tratamiento con corticosteroides sistémicos, a pesar de lo cual la paciente evolucionó desfavorablemente y falleció a los 15 días de su ingreso hospitalario. Este caso ilustra la asociación de esta enfermedad cutánea con trastornos oncohematológicos y el mal pronóstico que esto implica a corto plazo. (AU)
Bullous pyoderma gangrenosum is an infrequent type of pyoderma gangrenosum, associated with onco hematological diseases in 50-70% of cases. We present the case of a 59-year-old patient with fever and mucocutaneous hemorrhagic bullous of rapid progression. A biopsy for histopathology, direct immunofluorescence (DIF) and skin culture was made, considering the possibility of neutrophilic dermatoses, bullous dermatosis or an opportunistic infection. The results of both the culture and the DIF were negative. The histopathological examination of the specimen revealed a dense dermal polymorphic infiltrate composed primarily of neutrophils. Considering bullous pyoderma gangrenosum as a potential diagnosis, a bone-marrow biopsy was performed. This study revealed an acute myeloid leukemia. Although systemic corticosteroid therapy was begun, the patient presented an unfavorable evolution that led to her death 15 days after her admission at the hospital. This case shows the association between bullous pyoderma gangrenosum and onco hematological diseases. In addition, it highlights the poor prognosis related to these diseases in the short term. (AU)
Subject(s)
Humans , Female , Middle Aged , Leukemia, Myeloid, Acute/pathology , Pyoderma Gangrenosum/diagnosis , Paraneoplastic Syndromes/pathology , Respiration, Artificial , Azacitidine/therapeutic use , Myelodysplastic Syndromes/pathology , Acyclovir/administration & dosage , Methylprednisolone/administration & dosage , Vancomycin/administration & dosage , Cardiotonic Agents/therapeutic use , Ceftazidime/administration & dosage , Amphotericin B/administration & dosage , Imipenem/administration & dosage , Sweet Syndrome/etiology , Pyoderma Gangrenosum/etiology , Pyoderma Gangrenosum/pathology , Pyoderma Gangrenosum/drug therapy , Adrenal Cortex Hormones/therapeutic use , Meropenem/administration & dosageABSTRACT
Abstract Pyoderma gangrenosum is a neutrophilic dermatosis characterized by chronic ulcers due to an abnormal immune response. Despite the existence of diagnostic criteria, there is no gold standard for diagnosis or treatment. In Latin America, recognizing and treating pyoderma gangrenosum is even more challenging since skin and soft tissue bacterial and non-bacterial infections are common mimickers. Therefore, this review aims to characterize reported cases of pyoderma gangrenosum in this region in order to assist in the assessment and management of this condition. Brazil, Mexico, Argentina, and Chile are the countries in Latin America that have reported the largest cohort of patients with this disease. The most frequent clinical presentation is the ulcerative form and the most frequently associated conditions are inflammatory bowel diseases, inflammatory arthropaties, and hematologic malignancies. The most common treatment modalities include systemic corticosteroids and cyclosporine. Other reported treatments are methotrexate, dapsone, and cyclophosphamide. Finally, the use of biological therapy is still limited in this region.
Subject(s)
Humans , Pyoderma Gangrenosum/diagnosis , Pyoderma Gangrenosum/pathology , Prevalence , Pyoderma Gangrenosum/therapy , Pyoderma Gangrenosum/epidemiology , Diagnosis, Differential , Latin America/epidemiologyABSTRACT
RESUMEN El Pioderma Gangrenoso (PG) es una enfermedad inflamatoria necrotizante crónica, que pertenece al espectro de las dermatosis neutrofílicas. Histológicamente se caracteriza por mostrar un infiltrado inflamatorio denso de neutrófilos de origen no infeccioso. El PG suele asociarse a enfermedades sistémicas como la enfermedad inflamatoria intestinal, la artritis reumatoide o diversas enfermedades hematológicas. Presenta fenómeno de patergia y suele responder satisfactoriamente a tratamientos inmunosupresores. Su etiología no está bien definida. En la literatura se han publicado 15 casos de pioderma gangrenoso vulvar asociado al uso de rituximab. Nosotros presentamos un nuevo caso, que tuvo lugar en una mujer de 37 años en tratamiento de mantenimiento con rituximab por un linfoma no Hodgkin folicular. El rituximab (MabThera®) es un anticuerpo que reconoce la molécula CD20, que es una proteína no glucosilada que se expresa en la superficie de los linfocitos B. Este fármaco se ha utilizado para el tratamiento de diferentes enfermedades reumatológicas en los últimos años.
ABSTRACT Pyoderma Gangrenosum is a chronic necrotizing inflammatory disease that belongs to the spectrum of Neutrophilic Dermatoses. Histologically, it is characterized by a dense inflammatory infiltrate of non-infectious neutrophils. Etiology is not yet well defined. It is usually associated with systemic diseases such as inflammatory bowel disease, rheumatoid arthritis or hematological diseases. It presents pathergy phenomenon and usually respond satisfactorily to immunosuppressive treatments. There have been published only 15 cases of vulvar pyoderma gangrenosum associated with the use of rituximab. We present a new case, which occurred in a 37-year-old woman on maintenance treatment with rituximab for a follicular non-Hodgkin's lymphoma. Rituximab (MabThera®) is an antibody that recognizes the CD20 molecule, which is a non-glycosylated protein that is expressed on the surface of B lymphocytes. This drug has been used for the treatment of different rheumatic diseases in recent years.
Subject(s)
Humans , Female , Adult , Vulvar Diseases/drug therapy , Pyoderma Gangrenosum/diagnosis , Pyoderma Gangrenosum/drug therapy , Rituximab/adverse effects , Skin Diseases/pathology , Pyoderma Gangrenosum/epidemiology , Rituximab/administration & dosageABSTRACT
Pioderma gangrenoso é uma doença caracterizada por úlceras dolorosas, com bordos imprecisos, de diversos tamanhos e profundidade. O diagnóstico é eminentemente clínico, sendo muitas vezes de exclusão. O tratamento não é específico. O desbridamento cirúrgico não é indicado devido a seu potencial de patergia. Neste trabalho, relatamos um caso de pioderma gangrenoso em uma paciente submetida à abdominoplastia.
Pyoderma gangrenosum is a disease characterized by painful ulcers, with imprecise borders of various sizes and depth. The diagnosis is essentially clinical and often exclusionary. The treatment is not specific. Surgical debridement is not indicated because of its potential pathergy. We report a case of pyoderma gangrenosum in a patient who underwent abdominoplasty.
Subject(s)
Humans , Female , Adult , History, 21st Century , Postoperative Complications , Ulcer , Ciprofloxacin , Pyoderma Gangrenosum , Abdomen , Abdominoplasty , Surgical Wound , Postoperative Complications/surgery , Ulcer/pathology , Ciprofloxacin/therapeutic use , Pyoderma Gangrenosum/surgery , Pyoderma Gangrenosum/diagnosis , Pyoderma Gangrenosum/pathology , Abdominoplasty/methods , Surgical Wound/surgery , Surgical Wound/drug therapy , Abdomen/surgeryABSTRACT
Pyoderma gangrenosum is a rare, ulcerative, non-infectious neutrophilic dermatosis, commonly associated with underlying systemic disease. The features of pyoderma gangrenosum are not specific histopathologically and for this reason the diagnosis is based on clinical feature. The systemic administration of corticosteroids is the mainstay of treatment. We present five cases of pyoderma gangrenosum of age group ranging from 2 to 75 years. One of these patients was HIV-infected, and one was having discoid lupus erythematosus. The lesions were present on thighs in 3 cases, over back in one and breast in one. Biopsy showed central necrosis with multiple neutrophilic abscesses in epidermis. The dermis showed dense neutrophilic infiltration in both superficial and deep dermis. The lesions responded well to oral corticosteroids except in the case of HIV-infected patient in which minocycline showed considerable improvement.
Subject(s)
Adolescent , Adult , Aged , Child, Preschool , Female , HIV Infections/complications , Humans , Middle Aged , Minocycline/administration & dosage , Male , Minocycline/therapeutic use , Prednisolone/administration & dosage , Prednisolone/therapeutic use , Pyoderma Gangrenosum/diagnosis , Pyoderma Gangrenosum/drug therapy , Pyoderma Gangrenosum/pathologyABSTRACT
No abstract available.
Subject(s)
Adult , Humans , Male , Antineoplastic Agents/therapeutic use , Biopsy , Cladribine/therapeutic use , Leukemia, Hairy Cell/complications , Pyoderma Gangrenosum/diagnosis , Remission Induction , Time Factors , Treatment OutcomeABSTRACT
Varón de 42 años a quien se diagnosticó pioderma gangrenoso de manera extensa, en sus formas vesicular, bulosa y ulcerativa simultáneamente, como manifestación inicial de colitis ulcerativa. Cumplió con criterios clínicos para la lesión dérmica, así como endoscópicos e histológicos para colitis ulcerativa. Tuvo respuesta clínica favorable a corticosteroides y sulfusalazina por vía oral...
A 42 year-old man whom an extense pyoderma gangrenosum was diagnosed with simultaneously vesicular, bullous and ulcerative skin lesions as an initial manifestation of ulcerative colitis is presented. It met clinical criteria for dermal lesion as well as endoscopic and histologic features for ulcerative colitis. The clinical response was excellent to corticosteroids and sulfasalazin orally after a week of treatment...
Subject(s)
Humans , Male , Adult , Colitis, Ulcerative , Pyoderma Gangrenosum , Pyoderma Gangrenosum/diagnosis , Pyoderma Gangrenosum/therapyABSTRACT
El pioderma gangrenoso es una enfermedad cut nea ulcerativa cr¢nica, recurrente y rara. Su etiopatogenia es a£n incierta pero la asociaci¢n con enfermedadessistmicas orienta a una alteraci¢n inmunol¢gica. Se conocen cuatro variantes cl¡nicas y la m s com£nn es la forma ulcerativa. El diagn¢stico es cl¡nico y de descarte. La histolog¡a se caracteriza por un infiltrado neutrof¡lico de la dermis. El tratamiento de elecci¢n son los glucocorticoides orales. Se reporta n caso representativo de pioderma gangrenosa ulcerativo asociado a lupus eritematoso sistmico.
The pyoderma gangrenosum is a cutaneous illness ulcerative chronic, recurrent and rare. Its pathogenesis is still unclear, but the association with systemic diseases directed to an inmunological disorder. The diagnosis is clinical and discard. The histology is characterized by neutrophilic infiltrate of the dermis. The treatment of choice is oral corticosteroids. We report a typical case of ulcerative pyoderma gamgrenosum associated with systemic lupus erythematosus.
Subject(s)
Humans , Female , Child , Medical Illustration , Pyoderma Gangrenosum , Pyoderma Gangrenosum/diagnosis , Pyoderma Gangrenosum/therapyABSTRACT
Se presenta un paciente de sexo masculino, trasplantado renal, medicado con ciclosporina A 140 mg cada 12 hs, acido micofenólico 360 mg cada 12 hs, metilprednisolona 30 mg/ día, acido fólico 5 mg/día, ranitidina 150 mg/día, aciclovir 200 mg cada 8 hs, calcio 500 mg/día, insulina NPH 10 U/día y amlodipina 5 mg/día. Se le diagnostica pioderma gangrenoso (PG) tipo ulcerativo localizado en tobillo izquierdo. Se inicia tratamiento con tacrolimus tópico 0,1% 2 veces por día, logrando una excelente respuesta con cicatrización de la lesión a los 5 meses. Se destaca la aparición de esta enfermedad en un paciente que a pesar de estar bajo tratamiento inmunosupresor con drogas que son de indicación para el tratamiento del PG, desarrolla la patología. El PG es una enfermedad cutánea ulcerativa crónica, recurrente y poco frecuente, cuyo diagnóstico requiere una correlación clínicopatológica y se asocia con frecuencia a enfermedades sistémicas...
Subject(s)
Humans , Male , Kidney Transplantation , Pyoderma Gangrenosum/diagnosis , Immunosuppressive AgentsABSTRACT
El pioderma gangrenoso (PG) es una enfermedad de etiología desconocida, que se incluye en el grupo de las dermatosis neutrofílicas. Se reconocen cuatro variantes clínicas: ulcerativa,ampollar, pustulosa y vegetante. Puede presentarse en asociación con una enfermedad sistémica en aproximadamente el 50% de los casos. Para el diagnóstico es importantela exclusión de otras patologías, ya que no hay hallazgos específicos de laboratorio ni histopatológicos. Su manejo requiere tratamiento local y con frecuencia sistémico. Se presentan dos casos de PG ulcerosa...
Subject(s)
Humans , Male , Female , Pyoderma Gangrenosum/classification , Pyoderma Gangrenosum/diagnosis , Pyoderma Gangrenosum/pathology , UlcerABSTRACT
Background: Pyoderma gangrenosum (PG) is an uncommon inflammatory and ulcerative disorder of the skin. It may be associated with immune deficiencies. It is usually located in the extremities and its appearance after reduction mammoplasty is exceptional. We report three patients with the disease. A 54 years old female subjected to a bilateral reduction mammoplasty with an inferior pedicle. She developed a pyoderma gangrenosum and was treated with systemic steroids and local application of Dapsone with remission of lesions and healing after one month of evolution. A 23 years old women subjected to the same surgical procedure, which developed a wound dehiscence with ulcerative lesions, was treated with steroids and Azathioprine, reducing the local inflammation but leaving a severe esthetic sequel. A 21 years old woman subjected to the same surgical procedure, develop bilateral wound dehiscence and ulcerative lesions, she was treated with steroids and antimicrobials achieving a secondary healing...
Introducción: El Pioderma Gangrenoso es una enfermedad poco frecuente, de difícil diagnóstico y manejo. Puede estar asociado a otras enfermedades, en donde la alteración de la respuesta inmune es común. Su presentación por lo general corresponde a lesiones ulceradas de la piel ubicadas con frecuencia en las extremidades, siendo su presentación en las mamas excepcional; y mucho más rara su relación post mamoplastía de reducción. Métodos: Se realizó una revisión de pacientes sometidas a mamoplastía de reducción con pedículo inferior, asociadas al desarrollo de pioderma gangrenoso post-quirúrgico, durante un período comprendido entre los años 2000 y 2011. Resultados: Se recolectaron 3 pacientes, se describen sus casos clínicos con respecto a esta ubicación, analizando su presentación, evolución y manejo de la enfermedad. Discusión: La presentación del pioderma gangrenoso post-quirúrgico en relación a la mamoplastía de reducción comparte ciertas similitudes, las cuales deben orientar al diagnóstico precoz y de esta forma evitar manejos erróneos que pueden ser deletéreos, secuelantes e incluso potencialmente mortales...
Subject(s)
Humans , Adult , Female , Middle Aged , Breast Diseases/diagnosis , Breast Diseases/drug therapy , Mammaplasty/adverse effects , Pyoderma Gangrenosum/diagnosis , Pyoderma Gangrenosum/drug therapy , Anti-Infective Agents , Breast Diseases/etiology , Pyoderma Gangrenosum/etiologyABSTRACT
Introdução: A cocaína é extraída das folhas do arbusto da coca (Erythroxylon coca), podendo ser consumida de várias formas, mas o modo mais comum é pela aspiração da droga, sendo absorvida pela mucosa nasal, causando vasoconstricção, levando o seu uso crônico à perfuração de septo nasal. Pioderma gangrenoso é uma doença inflamatória rara, idiopática que se caracteriza pela presença de úlceras destrutivas principalmente em membros inferiores. Seu diagnóstico clínico é muitas vezes de exclusão. Objetivo: Descrever a raridade de associação entre Pioderma Gangrenoso e cocaína. Relato de Caso: E. A., 27 anos, com apresentação atípica de Pioderma Gangrenoso com perfurações de septo nasal e palato duro usuária de grande quantidade de cocaína, sendo necessário diferenciar qual patologia causou esse dano. Comentários Finais: Além da necessidade dessa diferenciação, apenas existem três casos relatados na literatura, envolvendo o Pioderma Gangrenoso complicado com perfuração de septo nasal em usuários de cocaína...
Introduction: The cocaine is obtained from the leaves of the coca (Erythroxylon coca). It can be used in many ways, but the most common is the drug inhalation. The Cocaine also causes vasoconstriction at nasal mucous membrane and its chronic use can cause necrosis and nasal septum perforation. Pyoderma gangrenosum is an uncommon idiopathic disease characterized by ulcerations, usually observed on the legs. Its diagnosis is most common an exclusion of others diseases. So far, there is no specific treatment based on evidence by randomized controlled trials. Objective: Describe the rare association between Pyoderma gangrenosum and cocaine. Case Report: E. A., 27-year-old woman with destruction of nasal septum and palate who has been using a big amount of cocaine, been necessary note the difference from which disease cause de damage. Final Comments: Also there are only three cases of Pyoderma gangrenosum complicated with nasal septum perforation in cocaine users...
Subject(s)
Humans , Female , Adult , Cocaine/adverse effects , Palate, Hard/physiopathology , Nasal Septal Perforation/diagnosis , Nasal Septal Perforation/physiopathology , Pyoderma Gangrenosum/diagnosis , Pyoderma Gangrenosum/etiology , Cocaine-Related Disorders/pathologyABSTRACT
Pyoderma gangrenosum is a rare neutrophilic disease of unknown origin that is associated with systemic diseases in 50% of cases. It is characterized by erythematous-violaceous nodular lesions that quickly progress to painful ulcers, with undermined edges, necrotic-hemorrhagic, varying in size and depth, located mainly in the lower limbs. Extracutaneous locations of pyoderma gangrenosum are rare, usually involving the lungs; the main differential diagnosis in these cases is Wegener granulomatosis. We report a case of pyoderma gangrenosum, which showed multiple cavitary lung nodules, with good response to high doses of steroids. Once excluded the possibility of Wegener granulomatosis, the authors concluded that it was the manifestation of systemic pyoderma gangrenosum with pulmonary involvement.
Pioderma gangrenoso é doença neutrofílica rara de etiologia desconhecida, que se associa a doenças sistêmicas em 50% dos casos. Caracteriza-se clinicamente por lesão nodular eritematoviolácea ou pústula que progride rapidamente para úlcera dolorosa, de bordas irregulares, fundo necrohemorrágico e localização preferencial nos membros inferiores. Manifestações sistêmicas do Pioderma gangrenoso são raras, envolvem geralmente os pulmões e o principal diagnóstico diferencial nestes casos é a granulomatose de Wegener. Relatamos um caso de paciente portador de pioderma gangrenoso que apresentava múltiplos nódulos pulmonares cavitados, com boa resposta a altas doses de corticoterapia. Uma vez excluída a possibilidade de granulomatose de Wegener, os autores concluíram tratar-se da manifestação sistêmica do pioderma gangrenoso.
Subject(s)
Adolescent , Humans , Male , Multiple Pulmonary Nodules/diagnosis , Pyoderma Gangrenosum/diagnosis , Granulomatosis with Polyangiitis/diagnosis , Diagnosis, Differential , Multiple Pulmonary Nodules/etiology , Pyoderma Gangrenosum/complicationsABSTRACT
Pioderma gangrenoso es una patología inflamatoria crónica, poco frecuente, de probable etiología autoinmune. Se asocia en 50 por ciento de los casos a múltiples enfermedades sistémicas. En su forma clásica, se presenta como una lesión ulcerativa, dolorosa, habitualmente en extremidades inferiores. El diagnóstico es clínico. La histología es inespecífica, pero permite descartar otras patologías como infecciones o neoplasias. No existe hasta el momento un único tratamiento efectivo para esta enfermedad. Los corticoides sistémicos en dosis continua o en pulsos, son efectivos en la mayoría de los casos. Se reserva el uso de inmunosupresores para los casos refractarios a tratamiento. Las nuevas terapias biológicas han mostrado buenos resultados, especialmente en pacientes con enfermedad inflamatoria intestinal asociada.
Pyoderma gangrenosum is a chronic inflammatory disease of probable autoimmune etiology. It is associated in 50 percent of cases to multiple systemic diseases. It usually presents as a painful ulcerative lesion. The legs are most commonly affected. The diagnosis is based on the clinical presentation. The objective of biopsy is to rule out other causes of ulceration, such as infections or malignancies. There is no specific and uniformly effective therapy for this disease. Systemic corticosteroids, administered continuously or in pulses, have been an effective treatment in most cases. We reserve the use of immunosuppressant for cases refractory to treatment. New biological therapies have shown good results, especially in patients with inflammatory bowel disease.
Subject(s)
Humans , Pyoderma Gangrenosum/diagnosis , Pyoderma Gangrenosum/drug therapy , Biological Therapy , Clinical Evolution , Adrenal Cortex Hormones/therapeutic use , Diagnosis, Differential , Inflammatory Bowel Diseases/complications , Prognosis , Pyoderma Gangrenosum/complicationsABSTRACT
Pyoderma gangrenosum is a rare inflammatory skin condition characterized by progressive and recurrent skin ulceration of destructive course. It is usually associated with rheumatoid arthritis, paraproteinemia, myeloproliferative diseases and inflammatory bowel diseases, especially non-specific ulcerative proctocolitis. In these situations, skin lesions are described as concurrent with the intestinal condition. However, reports on pyoderma gangrenosum preceding intestinal findings are less frequent. The authors describe a case of a woman with febrile condition associated with skin lesions diagnosed by biopsy as pyoderma gangrenosum. Two weeks later, she developed diarrhea, arthralgia and sepsis, being diagnosed as ulcerative proctocolitis. After the administration of the treatment for ulcerative proctocolitis, she showed improvements in sepsis care, remission of diarrhea and regression of skin lesions. This case highlights the importance of considering pyoderma gangrenosum as a manifestation associated with inflammatory bowel disease, regardless of its timing in relation to intestinal symptoms. (AU)
Pioderma gangrenoso é uma forma de inflamação cutânea, caracterizada por ulceração progressiva e recorrente da pele, com curso destrutivo. Geralmente é associada à artrite reumatoide, paraproteinemia, doenças mieloproliferativas e doença inflamatória intestinal, em especial retocolite ulcerativa inespecífica. Em tais casos, as lesões cutâneas são descritas concomitantes ao quadro intestinal, porém, relatos com descrição de pioderma gangrenoso precedendo achados intestinais são menos frequentes. Os autores relatam caso de mulher com quadro febril associado a lesões cutâneas diagnosticadas por biópsia como pioderma gangrenoso. Duas semanas depois, apresentou diarreia, artralgia e sepse sendo diagnosticada retocolite ulcerativa. Com o tratamento para retocolite ulcerativa apresentou melhora do quadro séptico, remissão da diarreia e regressão das lesões cutâneas. Este caso enfatiza a importância em considerar o pioderma gangrenoso como manifestação associada à doença inflamatória intestinal, independente de sua temporalidade em relação aos sintomas intestinais. (AU)
Subject(s)
Humans , Female , Middle Aged , Proctocolitis/complications , Pyoderma Gangrenosum/diagnosis , Inflammatory Bowel Diseases , Pyoderma Gangrenosum/etiology , Pyoderma Gangrenosum/therapyABSTRACT
Pioderma gangrenoso é uma doença inflamatória imunomediada e rara da pele, de diagnóstico extremamente desafiador. A evolução clínica é a base para o diagnóstico, cursando com lesões pustulosas superficiais, halo eritematoso doloroso, rápida progressão para ulcerações dolorosas eestéreis, sem resposta a antibióticos ou a novas intervenções cirúrgicas e, finalmente, com pronta melhora com uso de imunossupressores. O atraso no diagnóstico pode acarretar numerosas internações e terapias prolongadas, sendo que, seu reconhecimento precoce, por outro lado, evita a progressão dessas ulcerações e sua morbidade. Relatou-se um caso de pioderma gangrenoso que evoluiu após cirurgia associada à radioterapia intraoperatória no tratamento conservador do câncer de mama, fazendo-se uma revisão de casos relatados na literatura e suas possibilidades terapêuticas. Questiona-se também se a radioterapia intraoperatória estaria relacionada com algum estímulo imunomediado, o que poderia ter facilitado o desencadeamento do quadro.
Pyoderma gangrenosum is a rare immune-mediated inflammatory disease of skin, which diagnosis is extremely challenging. The clinical course is the basis for diagnosis, coursing with superficial pustular lesions, erythematous halo, rapid progression to painful ulcerations and unresponsive to antibiotics or surgical interventions, and finally, with immediate improvement with the use of immunosuppressant.The delay in diagnosis can result in numerous hospitalizations and prolonged therapy, and its early recognition, moreover, prevents the progression of these ulcers and its morbidity. There was reported a case of pyoderma gangrenosum that developed after surgery associated with intraoperative radiotherapyin conservative treatment of breast cancer, making up a review of cases reported and their therapeutic possibilities. One may wonder also if the intraoperative radiotherapy would be associated with some immune-mediated stimulus, which could have facilitated the onset of the condition.
Subject(s)
Humans , Female , Middle Aged , Brachytherapy/adverse effects , Breast Neoplasms/complications , Pyoderma Gangrenosum/diagnosis , Pyoderma Gangrenosum/therapy , Radiotherapy/adverse effectsABSTRACT
Se presenta caso de mujer adulta con múltiples lesiones ampollosas de 1 semana de evolución, acompañada de fiebre. Presentaba antecedentes de rectorragias ocasionales desde hace varios años. La colonoscopía detectó la presencia de Enfermedad inflamatoria intestinal, que se confirmó con la anatomía patológica. La biopsia de piel fue compatible con pioderma gangrenoso. La paciente mejoró con prednisona y aziatropina.
A case report of adult female with multiple bullous lesions of 1 week duration, accompanied by fever. She had a history of occasional rectal bleeding for several years. The colonoscopy detected the presence of inflammatory bowel disease, which was confirmed by pathology. Skin biopsy was consistent with pyoderma gangrenosum. The patient improved with prednisone and aziatropina.