The great mimicker: A case report of an extensive pyoderma gangrenosum in a 39-year-old Filipino female treated with systemic corticosteroids and antibiotics

Introduction@#Pyoderma gangrenosum (PG) is a rare inflammatory disease with unknown etiology. Ulcerative PG presents with a rapidly enlarging painful ulcer with erythematous and undermined border often misdiagnosed as infection, vascular disorder, malignancy, and other inflammatory disease. Hence, this poses a diagnostic challenge for clinicians leading to a delay in the management and significant morbidity. The treatment of PG is equally challenging due to the rarity of the disease and the scarcity of clinical trials. Currently, there are no clinical practice guidelines for the management of PG. @*Case Report@#Our patient presented with multiple large ulcers with erythematous and undermined borders over the chest, abdomen, and the lower back. Cribriform scars and contractures were noted as well. She underwent several sessions of surgical debridement and was given different broad-spectrum antibiotics with noted worsening of the lesions. Due to extensive involvement of the disease, her quality of life has been significantly affected. A diagnosis of PG was made after the biopsy showed predominantly neutrophilic infiltrate. Prednisone 1mg/kg/day and clobetasol propionate ointment were initiated with significant decrease in pain and size of the ulcers after one month of therapy. Doxycycline was used as an adjunct therapy with excellent response.@*Conclusion@#Pyoderma gangrenosum is a rare, debilitating disease that remains a diagnostic dilemma. The worsening of ulcers despite surgical debridement and antibiotics is a clue that should prompt clinicians to consider PG. This case highlights the important role of dermatology in individuals who present with non-healing chronic ulcers because as seen in this case, not all ulcers are just ulcers.

Dapsone-induced hemolytic anemia in non-G6PD deficient leprosy patients receiving multidrug therapy in Southern Philippines Medical Center: A retrospective study

Background@#Due to the high prevalence and incidence of leprosy in the Philippines, there is a continuing need to detect and document the occurrence of dapsone-induced hemolytic anemia. @*Objective@#The aim of this study is to determine the incidence of dapsone-induced hemolytic anemia in non-glucose-6-phosphate dehydrogenase deficient leprosy patients receiving multidrug therapy (MDT) in Southern Philippines Medical Center.@*Methodology@#This is a retrospective study through chart review of leprosy patients treated with MDT regimen at Southern Philippines Medical Center from January 2016 to December 2018. The demographic profile, clinical characteristics, hemoglobin and hematocrit concentrations before and after initiation of MDT, the presence of symptoms of anemia, and the occurrence of dapsone-induced hemolytic anemia in leprosy patients were collected. The main outcome measure for this study was the incidence rate of dapsone- induced hemolytic anemia. Statistical-based analysis were used for continuous and categorical data which were summarized using means and standard deviations, and frequencies and percentages, respectively.@*Results@#There was a decrease in the mean hemoglobin and hematocrit levels noted in the majority of patients after initiation of MDT from baseline 143.46 g/dl and 0.44, respectively, to 94 g/dl and 0.28 on the third month of MDT. The incidence rate of dapsone-induced hemolytic anemia during the 3-year period was 20 cases per 100.@*Conclusion@#The relatively high incidence rate of dapsone-induced hemolytic anemia highlights the importance of frequent monitoring of hemoglobin and hematocrit concentrations in leprosy patients being treated with multidrug therapy.