Successful treatment of pyoderma gangrenosum in a patient winh ulcerative colitis and COVID-19 infection: case report

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Abstract

Pyoderma gangrenosum is a rare inflammatory neutrophilic dermatosis, which causes ulceration of the skin. The condition is commonly associated with underlying systemic disorders such as inflammatory bowel disease, arthritis, and hematological disorders. Herein, we describe the case of a familiar association between pyoderma gangrenosum and ulcerative colitis complicated by the newly COVID-19 infection.

It is of particular clinical interest to address pyoderma gangrenosum lesions with concurrent treatment of associated disorders that may have influence on the course of the ulcer. Moreover, the therapy should cover as many diseases as possible while not being excessive to minimize possible side effects.

Thus, the selection of treatment that spans mutual pathophysiological features of all comorbidities represents the best option to make when handling pyoderma gangrenosum patients.

We present a case of the development of gangrenous pyoderma against the background of ulcerative colitis complicated by the new coronavirus infection COVID-19, which will raise awareness of gangrenous pyoderma as a relatively rare cause of ulcerative necrotic skin lesions, which can easily be confused with an infectious process.

Of particular clinical importance in the conditions of the COVID-19 pandemic is the correct treatment of gangrenous pyoderma. Only an integrated approach can give a positive result from the therapy.

About the authors

Nataliya P. Teplyuk

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: Teplyukn@gmail.com
ORCID iD: 0000-0002-5800-4800
SPIN-code: 8013-3256

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Olga V. Grabovskaya

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: olgadoctor2013@yandex.ru
ORCID iD: 0000-0002-5259-7481
SPIN-code: 1843-1090

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, Moscow

Diana T. Kusraeva

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: kysra1992@mail.ru
ORCID iD: 0000-0002-5633-7986
SPIN-code: 1478-3503

Postgraduate Student

Russian Federation, 4 build. 1, Bolshaya Pirogovskaya str., Moscow, 119991

Ekaterina V. Grekova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: grekova_kate@mail.ru
ORCID iD: 0000-0002-7968-9829
SPIN-code: 8028-5545

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Danila A. Koriakin

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: danila110920021@gmail.com
ORCID iD: 0000-0003-3619-206X

Student

Russian Federation, Moscow

Anastasia Yu. Kostenko

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: anastasiya.k9716@gmail.com
ORCID iD: 0000-0002-4115-540X

MD

Russian Federation, Moscow

References

  1. Marzano AV, Damiani G, Ceccherini I, et al. Autoinflammation in pyoderma gangrenosum and its syndromic form (pyoderma gangrenosum, acne and suppurative hidradenitis). Br J Dermatol. 2017;176(6):1588–1598. doi: 10.1111/bjd.15226
  2. Alavi A, French LE, Davis MD, et al. Pyoderma gangrenosum: an update on pathophysiology, diagnosis and treatment. Am J Clin Dermatol. 2017;18(3):355–372. doi: 10.1007/s40257-017-0251-7
  3. Kridin K, Cohen AD, Amber KT. Underlying systemic diseases in pyoderma gangrenosum: a systematic review and meta-analysis. Am J Clin Dermatol. 2018;19(4):479–487. doi: 10.1007/s40257-018-0356-7
  4. Su WP, Davis MD, Weenig RH, et al. Pyoderma gangrenosum: clinicopathologic correlation and proposed diagnostic criteria. Int J Dermatol. 2004;43(11):790-800. doi: 10.1111/j.1365-4632.2004.02128.x
  5. Georgin-Lavialle S, Ducharme-Benard S, Sarrabay G, et al. Systemic autoinflammatory diseases: Clinical state of the art. Best Pract Res Clin Rheumatol. 2020;34(4):101529. doi: 10.1016/j.berh.2020.101529
  6. Barbosa NS, Tolkachjov SN, El-Azhary RA, et al. Clinical features, causes, treatments, and outcomes of peristomal pyoderma gangrenosum (PPG) in 44 patients: The Mayo Clinic experience, 1996 through 2013. J Am Acad Dermatol. 2016;75(5):931–939. doi: 10.1016/j.jaad.2016.05.044
  7. Ashchyan HJ, Butler DC, Nelson CA, et al. The association of age with clinical presentation and comorbidities of pyoderma gangrenosum. JAMA Dermatol. 2018;154(4):409–413. doi: 10.1001/jamadermatol.2017.5978
  8. Goodarzi H, Sivamani RK, Garcia MS, et al. Effective strategies for the management of pyoderma gangrenosum. Adv Wound Care (New Rochelle). 2012;1(5):194–199. doi: 10.1089/wound.2011.0339
  9. Teplyuk NP, Grabovskaya OV, Kusraeva DT, Varshavsky VA. Pyoderma gangrenosum: examination and treatment experience. Russian journal of skin and venereal diseases. 2022;25(1):61–72. (In Russ). doi: 10.17816/dv105685
  10. Olisova OY, Anpilogova EM. New coronavirus infection (COVID-19): a dermatologist’s view. Annals of the Russian academy of medical sciences. 2020;75(4):292–299. (In Russ). doi: 10.15690/vramn1359
  11. Genovese G, Moltrasio C, Berti E, Marzano AV. Skin manifestations associated with COVID-19: current knowledge and future perspectives. Dermatology. 2021;237(1):1–12. doi: 10.1159/000512932
  12. Borges L, Pithon-Curi TC, Curi R, Hatanaka E. COVID-19 and neutrophils: the relationship between hyperinflammation and neutrophil extracellular traps. Mediators Inflamm. 2020;2020:8829674. doi: 10.1155/2020/8829674
  13. Patel F, Fitzmaurice S, Duong C, et al. Effective strategies for the management of pyoderma gangrenosum: A comprehensive review. Acta Derm Venerol. 2015;95(5):525–531. doi: 10.2340/00015555-2008
  14. Soto Vilches F, Vera-Kellet C. Pyoderma gangrenosum: classic and emerging therapies. Medicina Clínica (English Edition). 2017;149(6):256–260. doi: 10.1016/j.medcle.2017.08.007
  15. Schwartz RA, Pradhan S, Murrell DF, et al. COVID-19 and immunosuppressive therapy in dermatology. Dermatologic Therapy. 2020;33(6):e14140. doi: 10.1111/dth.14140
  16. Tatiya-Aphiradee N, Chatuphonprasert W, Jarukamjorn K. Immune response and inflammatory pathway of ulcerative colitis. J Basic Clin Physiol Pharmacol. 2018;30(1):1–10. doi: 10.1515/jbcpp-2018-0036
  17. Syed K, Chaudhary H, Balu B. Pyoderma gangrenosum following COVID-19 infection. J Community Hosp Intern Med Perspect. 2021;11(5):601–603. doi: 10.1080/20009666.2021.1958492
  18. Kochar B, Herfarth N, Mamie C, et al. Tofacitinib for the treatment of pyoderma gangrenosum. Clin Gastroenterol Hepatol. 2019;17(5):991–993. doi: 10.1016/j.cgh.2018.10.047
  19. Fauny M, Moulin D, D’Amico F, et al. Paradoxical gastrointestinal effects of interleukin-17 blockers. Ann Rheum Dis. 2020;79(9):1132–1138. doi: 10.1136/annrheumdis-2020-217927
  20. Mikail M, Wilson A. Infliximab treatment for large, multifocal, abdominal pyoderma gangrenosum associated with ulcerative colitis: a case report. SAGE Open Med Case Rep. 2020;8:2050313X20964113. doi: 10.1177/2050313X20964113
  21. Kleinpenning MM, Langewouters AM, van De Kerkhof PC, Greebe RJ. Severe pyoderma gangrenosum unresponsive to etanercept and adalimumab. J Dermatolog Treat. 2011;22(5):261–265. doi: 10.3109/09546631003797106
  22. Guenova E, Teske A, Fehrenbacher B, et al. Interleukin 23 expression in pyoderma gangrenosum and targeted therapy with ustekinumab. Arch Dermatol. 2011;147(10):1203–1205. doi: 10.1001/archdermatol.2011.168
  23. Pichler M, Thuile T, Gatscher B, et al. Systematic review of surgical treatment of pyoderma gangrenosum with negative pressure wound therapy or skin grafting. J Eur Acad Dermatol Venereol. 2017;31(2):e61–e67. doi: 10.1111/jdv.13727

Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Patient, 72 years old. Ulcerative pyoderma gangrenosum. Оval ulcer on the skin of the abdomen 24×45 cm in size with the undermined edge with violaceous borders, the surface of the ulcer is filled with fibrin granulations.

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3. Fig. 2. The same patient. Histologic image: mixed inflammatory infiltrate with a predominance of neutrophils and signs of leukocytoclastic vasculitis. Hematoxylin and eosinstaining, ×200.

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4. Fig. 3. The same patient. External therapy: а ― topical corticosteroids along the periphery to the area of erythema; b ― application of a nonadhesive lipidоcolloid wound dressing.

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5. Fig. 4. The same patient. Clinical image after the conducted treatment: complete scarring of the ulcer.

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Copyright (c) 2023 Teplyuk N.P., Grabovskaya O.V., Kusraeva D.T., Grekova E.V., Koriakin D.A., Kostenko A.Y.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
 


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