Rosina Paolo, Cunego Stefano, Franz Cristina Zambelli, D'Onghia Francesco Saverio, Chieregato Giancarlo
Section of Dermatology and Venereology, Department of Biomedical and Surgical Science, University of Verona, Italy.
Int J Dermatol. 2002 Mar;41(3):166-7. doi: 10.1046/j.1365-4362.2002.01373_1.x.
A 74-year-old woman was referred to our department in December 1999 for a pyoderma gangrenosum (PG) arising at the edges of chronic leg ulcer. The history was positive for benign monoclonal gammopathy, ischemic hypertensive cardiopathy, polyarthrosis and venous lower leg deficiency. Monoclonal gammopathy of IgA Kappa type was diagnosed 10 years before with a continued benign nature. In 1990 a post traumatic PG of the left leg was diagnosed and a therapy with Cyclosporine A was started with healing of the lesion. In June 1999, 6 months before the hospitalization, a typical venous ulcer of the right leg appeared and was treated with bed-rest, compression bandaging and topical desloughing therapy. In the last month, after a minor surgical debridement of the wound, the lesion developed pustules evolving into a painful, necrotic ulcer with ragged, purple-red, undetermined borders (Fig. 1). A relapse of PG was suspected. Histological examination was consistent with pyoderma gangrenosum and showed massive neutrophilic infiltration, hemorrhage and necrosis of the overlying epidermis. Wound culture was negative. Other laboratory examinations only showed IgA = 8.15 g/L. Investigation of other underlying medical conditions were normal or negative. The venous leg ulcer gradually healed with antiseptic and compression-bandage therapy. After a 4-month course of topical steroid therapy with good results, the PG recurred also involving the proximal area of the leg. Methylprednisolone 50 mg/day was started. Healing began 10 days later and 2 months later the wound healed and epithelialized. Steroid was reduce to 5 mg daily for 4 months. No recurrence was seen when the drug was stopped.
1999年12月，一名74岁女性因慢性腿部溃疡边缘出现坏疽性脓皮病（PG）被转诊至我科。病史显示患有良性单克隆丙种球蛋白病、缺血性高血压性心脏病、多关节病和下肢静脉功能不全。10年前诊断为IgA κ型单克隆丙种球蛋白病，病情持续呈良性。1990年诊断为左腿创伤后PG，开始使用环孢素A治疗，病变愈合。1999年6月，即住院前6个月，右腿出现典型的静脉溃疡，采用卧床休息、加压包扎和局部清创治疗。在过去一个月里，伤口进行了一次小手术清创后，病变处出现脓疱，发展为疼痛的坏死性溃疡，边界参差不齐、呈紫红色、界限不清（图1）。怀疑PG复发。组织学检查符合坏疽性脓皮病，显示大量中性粒细胞浸润、出血和表皮坏死。伤口培养结果为阴性。其他实验室检查仅显示IgA = 8.15 g/L。对其他潜在疾病的检查结果正常或为阴性。腿部静脉溃疡经抗菌和加压包扎治疗后逐渐愈合。经过4个月的局部类固醇治疗，效果良好，但PG复发，累及腿部近端区域。开始使用甲泼尼龙50 mg/天。10天后开始愈合，2个月后伤口愈合并上皮化。类固醇剂量减至每日5 mg，持续4个月。停药后未见复发。
