Pyoderma Gangrenosum: Clinical Manifestations

Case 4:Man With Ulcerative Colitis
This painful, eroded plaque on thedorsum of a 39-year-old man's handhad developed over a few days from asmall, painful pustule. The patient'shistory included ulcerative colitis,which was not active when the lesionoccurred.

After being admitted to the hospital,the patient was given intravenousantibiotics; however, after 3 daysof therapy, no improvement wasnoted. Bacterial cultures showed nogrowth. A biopsy of the lesion supportedthe clinical diagnosis of pyoderma gangrenosum.The patient's history of ulcerative colitis was a clue tothe diagnosis; the destructive cutaneous ulcers can occureven when the inflammatory bowel disease is inactive.Early pyoderma gangrenosum may mimic cellulitis.

The ulcer responded dramatically to systemic corticosteroids.Following a single recurrence of pyodermagangrenosum, the patient has been free of the disease forthe past 3 years.

(Case and photograph courtesy of Dr David L. Kaplan.)