Department of Respiratory, Peking University Shenzhen Hospital, Shenzhen, Gangdong, China.
Department of Diagnostic Radiology, Peking University Shenzhen Hospital, Shenzhen, Gangdong, China.
Intern Med J. 2019 Feb;49(2):247-251. doi: 10.1111/imj.14201.
Pyoderma gangrenosum (PG) is a rare and recurrent ulcerating, non-infectious, inflammatory dermatosis, with occasional concomitant extracutaneous manifestations. The pathogenesis and aetiology of PG are unknown. Moreover, early diagnosis is challenging because there are several visceral manifestations that may occur prior to the skin findings, such that misdiagnosis of PG as an infection is common. Here, we present a case of PG in which pulmonary and spleen lesions preceded the cutaneous manifestations. The correct diagnosis was made 6 months after multiple nodules were detected in the lung and spleen, based on the development of skin wound ulcers. To the best of our knowledge, this is the first report of PG in which pulmonary and splenic involvement preceded the appearance of skin lesions, without systemic disease. The patient was followed up for 5 years, during which time complete clinical and radiographic resolution was confirmed. This case demonstrates the challenges in the diagnosis of PG and the importance of using multiple diagnostic methods to determine the cause of unexplained clinical manifestations.
坏疽性脓皮病（PG）是一种罕见且反复发作的溃疡性、非传染性、炎症性皮肤病，偶尔伴有皮肤外表现。PG 的发病机制和病因尚不清楚。此外，早期诊断具有挑战性，因为有几种内脏表现可能先于皮肤表现出现，因此 PG 被误诊为感染很常见。在这里，我们报告了一例 PG，其肺部和脾脏病变先于皮肤表现。在肺部和脾脏出现多个结节 6 个月后，根据皮肤伤口溃疡的发展，做出了正确的诊断。据我们所知，这是首例无系统性疾病的 PG 中肺部和脾脏受累先于皮肤病变出现的病例。该患者接受了 5 年的随访，在此期间证实了完全的临床和影像学缓解。该病例表明了 PG 诊断的挑战，以及使用多种诊断方法确定不明原因临床表现原因的重要性。
