Complete genome sequence of a methicillin-resistant Staphylococcus schleiferi strain from canine otitis externa in Korea

Bullous Pyoderma Gangrenosum in a Child / 대한피부과학회지

We report a rare case of a bullous type of pyoderma gangrenosum in a pediatric patient. A 3-year-old female patient visited our department with recurrent hemorrhagic bullae and erosive patches for 1 year. Skin biopsy revealed a subepidermal blister with diffuse neutrophilic infiltrations in the dermis. The diagnosis of bullous pyoderma gangrenosum was made by exclusion of other diseases via bacterial culture, laboratory, and immunofluorescence studies. The skin lesions responded well to a low dose of systemic corticosteroid, but the lesions recurred frequently.

Hyperbaric oxygen therapy for pyoderma gangrenosum associated with ulcerative colitis

Pyoderma gangrenosum (PG), an ulcerating skin condition, is rare in patients with ulcerative colitis (UC). We report a case of successful treatment of PG in a patient with UC using hyperbaric oxygen therapy (HBOT). The patient had UC that was in remission following treatment with mesalazine and azathioprine therapy. After visiting an orthopedic clinic, the patient opted for treatment with antibiotics and daily dressing of the ulcerative skin lesions, while azathioprine was discontinued. However, the lesions did not improve. Two months later, the patient visited a dermatologist who diagnosed the lesions as PG, and he was admitted to our unit. Surgical debridement and HBOT were performed by a plastic surgeon in the emergency department. After 3 months of HBOT and topical treatment, the patient's PG completely resolved. His UC was still in remission with mesalazine alone. HBOT may be an effective and safe alternative treatment for PG associated with UC, particularly in patients in whom anti-tumor necrosis factor agents are unnecessary.

Multiple Pyoderma Gangrenosum in Ulcerative Colitis / 대한소화기학회지

No abstract available.

Two Cases of Postoperative Pyoderma Gangrenosum / 대한피부과학회지

Pyoderma gangrenosum (PG) is an uncommon ulcerating inflammatory neutrophilic dermatosis. Multifactorial pathogenesis has been reported because the underlying mechanism needs to be clearly elucidated. A pathergic reaction is a pathogenic aggravating factor of PG. The occurrence of postoperative PG (PPG) within and involving the borders of a surgical incision site suggests the role of a pathergic reaction in PG. Massive debridement should be avoided in PPG, and it should be immediately managed with oral prednisolone. We present 2 cases of PPG with different clinical courses according to the primary management.

A Case of Pyoderma Gangrenosum with Myelodysplastic Syndrome

No abstract available.

Saddle Nose Deformity as a Result of an Aseptic Nasal Abscess Accompanied by Ulcerative Colitis and Pyoderma Gangrenosum

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes granulomatous inflammation in the mucous membrane of the intestinal tract, especially in the colon. Additionally, UC can be accompanied by extraintestinal manifestation (EIM). EIM of UC includes cutaneous lesions such as pyoderma gangrenosum, and rarely, systemically occurring aseptic abscesses (AA) have been reported in a few cases. Nasal involvement of UC as an extraintestinal manifestation of IBD is rare, and few reports of nasal mucosa and septal cartilage involvement have been documented in the literature. However, aseptic nasal abscess involving septal cartilage associated with UC and pyoderma gangrenosum resulting in saddle nose deformity have not been reported. The author presents a case of a 52 year-old woman with UC and pyoderma gangrenosum and an aseptic abscess in the nasal septal cartilage resulting in saddle nose deformity, which was corrected by augmentation rhinoplasty.

Pyoderma Gangrenosum of the Preauricular Area with Ulcerative Colitis: A Case Report and Review

Pyoderma gangrenosum (PG) is primarily, a sterile, inflammatory, neutrophilic dermatosis, characterized by recurrent cutaneous ulceration with mucopurulent or hemorrhagic exudate. The incidence of PG is uncertain, but it is estimated to be about 3-10 patients per million per year. It occurs most commonly on the lower legs, but has been reported at other sites of the body as well. The causes of PG are unknown, but about 50-70% of cases are associated with other diseases, mainly inflammatory bowel disease. We hereby report a case of PG in a 21-year-old male, with a history of ulcerative colitis (UC). After appropriate diagnostic methods including biopsy for pathologic confirmation, sigmoidoscopy and computed tomography, we excluded other diseases and the lesion was diagnosed as PG. We then carried out regular dressing of the wound, while UC was treated with steroid and immunosuppressant medication, with inputs from the department of gastroenterology during the hospital stay. There occurred recurrence of the skin lesion, 7 months after discharge, after which they improved. UC has been in the remission state as per the follow-up, since 2 years.

Facial botryomycosis-like pyoderma in an HIV-infected patient: remission after initiation of darunavir and raltegravir

Abstract Botryomycosis is an uncommon, chronic, suppurative, bacterial infection that primarily affects the skin and subcutaneous tissues. It has long been associated with defects of cellular immunity. We report a 28-year-old woman who presented with a chronic, ulcerated lesion with draining sinuses in the right malar region. Predisposing factors were HIV infection with poor immunological control, alcoholism, and a previous trauma to the right cheek. Several courses of antimicrobial therapy provided only partial and temporary remission. Complete clinical remission was only achieved 5 years later when a novel antiretroviral regimen composed of darunavir and raltegravir was initiated.

Pyoderma Gangrenosum in a Patient with X-Linked Agammaglobulinemia

X-linked agammaglobulinemia (XLA) is a primary immunodeficiency disorder caused by germline mutations of B-cell tyrosine kinase (BTK) gene. It is characterized by decreased serum immunoglobulins levels and circulating mature B cells. This defect in humoral immunity leads to increased susceptibility to infection. Pyoderma gangrenosum (PG) is an uncommon, ulcerating, neutrophilic dermatosis. Here we report PG in an 8-year-old patient with XLA. The patient received intravenous immunoglobulin treatment in conjunction with prednisone and topical application of 0.03% tacrolimus ointment and the ulcer was almost completely healed in the 2 weeks of follow-up. The coexistence has been rarely reported. XLA may be a possible cofactor in the pathogenesis of PG.

Successful treatment of a patient with myelodysplastic syndrome accompanied by pyoderma gangrenosum and Behçet's disease using allogeneic stem cell transplantation

No abstract available.

Diagnosis of Churg-Strauss Syndrome Presented With Neuroendocrine Carcinoma: A Case Report

Churg-Strauss syndrome (CSS) is a rare systemic vasculitis that affect small and medium-sized blood vessels and is accompanied by asthma, eosinophilia, and peripheral neuropathy. This report describes a case of a 52-year-old man who had a history of sinusitis, asthma, and thymus cancer and who had complained of bilateral lower extremity paresthesia and weakness for a month. Peripheral neuropathy was detected by electrodiagnostic studies. Resection of a mediastinal mass, which was diagnosed as thymic neuroendocrine carcinoma, was performed five months before his visit. After thymectomy, peripheral blood tests revealed a gradual increase in eosinophils. Two months after surgery, he was admitted to the hospital for dyspnea, and nodules of focal consolidation were found in his chest X-ray. One month later, pyoderma occurred in the right shin, and the skin biopsy showed extravascular eosinophilic infiltration. He was diagnosed with CSS after thymectomy, and we report a very rare case of CSS presented with thymic neuroendocrine carcinoma.

Treatment of Recalcitrant Pyoderma Gangrenosum with Ulcerative Colitis by Adalimumab Injection

No abstract available.

Prevalence and in vitro susceptibility of methicillin-resistant Staphylococcus pseudintermedius (MRSP) from skin and nostrils of dogs with superficial pyoderma / Prevalência e suscetibilidade in vitro de Staphylococcus pseudintermedius resistente à meticilina (MRSP) oriundos de pele e narinas de cães com piodermite superficial

In order to assess the prevalence of Methicillin-resistant Staphylococcus pseudintermedius from skin and nostrils of dogs with pyoderma, to determine its in vitro susceptibility, and to correlate these data with the presence of the mecA gene, 43 dogs were selected. Samples were collected from secretion of their skin lesions and right nostril, cultured, and analyzed for phenotypic and genotypic characteristics of the bacteria studied. In 62 samples (91%) the microorganism was classified as S. pseudintermedius. The rate of resistance against antibiotics ranged from 7% (amikacin; 4/62) to 77% (sulfamethoxazole + trimethoprim; 48/62). Resistance against oxacillin was found in 34% of the samples (21/62). Twenty-five samples (37%) were strains that carried the mecA gene. A significant correlation (P<0.01) was found between presence of the mecA gene and oxacillin resistance. Seventeen dogs were mecA gene carriers, and 8 (47%) of them had the gene in the skin lesions and nostril. A significant correlation (P<0.01) was also observed between the presence of mecA gene in the skin lesions and nostrils. Oxacillin resistance in vitro can be safely used to indicate the presence of mecA gene in MRSP samples. The nostrils can be a reservoir of MRSP in dogs.(AU)

Para acessar a prevalência de MRSP na pele e nas narinas de cães com piodermite superficial, determinar a suscetibilidade in vitro, e correlacionar estes dados com a presença do gene mecA, foram selecionados 43 cães. Amostras de lesões de pele e narinas foram coletadas, cultivadas, e analisadas fenotipica e genotipicamente. Em 62 amostras (91%), os microrganismos foram classificados como Staphylococcus pseudintermedius. A taxa de resistência a antibióticos variou entre 7% (amicacina; 4/62) e 77% (sulfamethoxazol + trimetoprim; 48/62). Resistência a oxacilina foi observada em 34% das amostras (21/62). Vinte e cinco amostras (37%), eram cepas portadoras do gene mecA. Correlação significativa (P<0,01) foi observada entre a presença do gene mecA e a resistência à oxacilina. Considerando os cães, 17 eram portadores de cepas com gene mecA e 8(47%) delas carreavam este gene nas amostras de lesão de pele e nas narinas. Correlação significativa (P>0,01) foi observada entre a presença do gene mecA nas lesões de pele e nas narinas. Sendo assim, resistência à oxacilina in vitro pode ser aferida com segurança para indicar a presença do gene mecA em amostras de MRSP, e as narinas podem constituir em um reservatório dos microorganismos em cães.(AU)

Successful vaginal birth after prior cesarean section in a patient with pyoderma gangrenosum

Pyoderma gangrenosum is an extremely rare chronic cutaneous disease causing severe ulceration. It can be developed after minor trauma or surgical procedure. The typical features mimic acute infection site, however the treatment methods are opposing since pyoderma gangrenosum is improved with the use of corticosteroids, not antibiotic therapy. We here report a patient who had been diagnosed for acute infection after cesarean delivery in 2011 and treated with a number of antibiotics, but failed to recover. The patient had suffered from pain of the disease and also renal failure caused by antibiotics. Ultimately she had been diagnosed as pyoderma gangrenosum and managed successfully with steroids. For her next pregnancy in 2013, we tried vaginal delivery after prior cesarean section and it was uneventful during and after delivery.

Clinical Manifestation Patterns and Trends in Poststreptococcal Glomerulonephritis

Poststreptococcal glomerulonephritis (PSGN) is one of the most recognized diseases in pediatric nephrology. Typical clinical features include rapid onset of gross hematuria, edema, and hypertension, and cases are typically preceded by an episode of group A β-hemolytic streptococcus pharyngitis or pyoderma. The most common presenting symptoms of PSGN are the classic triad of glomerulonephritis: gross hematuria, edema, and hypertension . However, patients with PSGN sometimes present with unusual or atypical clinical symptoms that often lead to delayed diagnosis or misdiagnosis of the disease and increased morbidity. Additionally, the epidemiology of postinfectious glomerulonephritis (PIGN), including PSGN, has changed over the past few decades. This paper reviews atypical clinical manifestations of PSGN and discusses the changing demographics of PIGN with a focus on PSGN.

A double-blind, randomized controlled trial on the effectiveness and safety of 15% malunggay ointment (Moringa oleifera) vs 2% mupirocin ointment in treating localized pyoderma

BACKGROUND: Superficial bacterial infection is among the most common reasons for dermatologic consult. Numerous published articles suggest that the dried leaf of malunggay exhibits antibacterial property.OBJECTIVES: To compare the effectiveness and safety of 15% malunggay ointment with 2% mupirocin ointment in treating localized pyoderma.METHODS: Sixty-three patients with localized pyoderma (?10% of total body surface area) were enrolled in this randomized, double-blind study to apply either 15% malunggay or 2%  mupirocin ointment twice daily for 14 days. Clinical evaluation using the Global Assessment Score (GAS) for pruritus, pain, erythema, vesiculation, moistness and crusting were conducted at baseline and days 3, 7 and 14 of clinic visit. RESULTS: Both malunggay and mupirocin groups showed significant decreases in GAS from baseline to days 3, 7 and 14 of treatment (p=0.000, Repeated measures, ANOVA). By days 7 and 14, median GAS of malunggay ointment was higher than mupirocin (1 vs. 0, pCONCLUSION: Patients in the mupirocin treatment arm had significantly lower global assessment scores and higher cure rates compared to those in the malunggay treatment arm.

A Case of Multiple Bullous Pyoderma Gangrenosum Lesions on the Face of a Patient with Ulcerative Colitis / 대한피부과학회지

Pyoderma gangrenosum (PG) is rare chronic painful ulcerative skin disorder usually associated with various systemic diseases, the most common of which is inflammatory bowel disease (IBD). PG shows a particularly stronger correlation with ulcerative colitis than Crohn's disease. It generally occurs at sites of trauma (pathergy), butspontaneous lesions with no evident trauma are not uncommon. PG is classified into four major clinical types: ulcerative, pustular, bullous, and vegetating. The ulcerative type is mostly associated with IBD. On the other hand, the bullous type is known to be associated with lymphoproliferative disorders. We report a rare case of PG of the bullous types forming multiple lesions on the face of a 21-year-old Korean woman with ulcerative colitis.

Pioderma gangrenoso após quadrantectomia de mama com radioterapia intraoperatória: relato de caso / Pyoderma gangrenosum after quadrantectomy with intraoperative radiotherapy: a case report

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 e estéreis, 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 an immune-mediated inflammatory and rare skin disease with an extremely challenging diagnosis. The clinical evolution of the disease is the basis for the diagnosis that involves pustular superficial lesions, painful erythematous halo, rapid progression to painful and sterile ulcerations, unresponsiveness to antibiotics or new surgical interventions, and finally, ready improvement with the use of immunosuppressive drugs. Delayed diagnosis may cause numerous hospitalizations and prolonged therapy, whereas early recognition can prevent the progression of the ulcerations and their morbidities. We report a case of pyoderma gangrenosum that evolved after surgery and was associated with intraoperative radiotherapy for the conservative treatment of breast cancer. In addition, we reviewed reported cases in the literature and therapeutic options. It is conjectured that intraoperative radiotherapy might be related to some immune-mediated stimuli that could trigger the clinical condition.

Suscetibilidade antimicrobiana de Staphylococcus spp: isolados de cães com pioderma superficial / Antimicrobial susceptibility of Staphylococcus spp: isolated from canine superficial pyoderma

Foram obtidas 154 amostras de lesões cutâneas de cães com pioderma superficial atendidos no Serviço de Dermatologia Veterinária do Hospital Veterinário Universitário (HVU) da Universidade Federal de Santa Maria (UFSM), com o objetivo de determinar a suscetibilidade antimicrobiana de isolados de Staphylococcus spp. e avaliar a presença de multirresistência. Após isolamento e identificação, as cepas foram submetidas ao teste de sensibilidade aos antimicrobianos, cujos resultados evidenciaram menores percentuais de resistência à associação amoxicilina e ácido clavulânico (1,9 por cento), cefadroxil (1,9 por cento), cefalexina (1,9 por cento) e vancomicina (0,6 por cento). Os maiores percentuais de resistência foram frente à amoxicilina (60,4 por cento) e penicilina G (60,4 por cento). A multirresistência foi detectada em 23,4 por cento e a resistência à meticilina em 5,8 por cento das amostras. Pode-se concluir que os isolados de Staphylococcus spp. apresentam elevada suscetibilidade aos antimicrobianos comumente utilizados no tratamento dos piodermas superficiais em cães atendidos no HVU-UFSM, como a cefalexina e a amoxicilina associada ao ácido clavulânico, confirmando a eleição desses fármacos para o tratamento de cães com esta afecção. A suscetibilidade diminuída das cepas frente às fluoroquinolonas, também recomendadas pela literatura para o tratamento de pioderma, permite sugerir que estes fármacos não devem mais ser considerados na seleção empírica. A identificação de Staphylococcus spp. multirresistentes na população canina estudada justifica análises bacteriológicas periódicas e regionais de lesões cutâneas de cães com pioderma superficial, a fim de minimizar a seleção de bactérias resistentes, possíveis falhas terapêuticas e também motiva a antimicrobianoterapia prudente.

A total of 154 samples of skin lesions were obtained from dogs with superficial pyoderma that were assisted by the Veterinary Dermatology Service at the University Veterinary Hospital (HVU), Universidade Federal de Santa Maria (UFSM), aiming to determine the antimicrobial susceptibility of Staphylococcus spp. isolates and evaluate the presence of multidrug resistance profile. After bacterial isolation and identification, the strains were tested for antimicrobial susceptibility, and the results showed lower percentages of resistance to the amoxicillin and clavulanic acid association (1.9 percent), cefadroxil (1.9 percent), cephalexin (1.9 percent) and vancomycin (0.6 percent). The highest percentages were towards amoxicillin (60.4 percent) and penicillin G (60.4 percent). The multidrug resistance was detected in 23.4 percent and the methicillin resistance in 5.8 percent of the samples. It may be concluded that the Staphylococcus spp. isolates present high susceptibility to key antimicrobials used in the treatment of superficial pyodermas in dogs at the HVU-UFSM, such as cephalexin and the amoxicillin and clavulanic acid association, confirming the preference for these drugs when treating dogs with this disorder. The susceptibility of the strains to fluoroquinolones, also recommended in the literature for the treatment of pyodermas, allows suggesting that such drugs should not be considered in the empirical selection. The identification of multidrug-resistant Staphylococcus spp. in the studied canine population justifies periodic and regional bacteriological tests of skin lesions in dogs with superficial pyoderma, possible therapeutic failures and also motivates wise use of antimicrobial therapy.