Gallou S, Madelaine J, Planchard G, Dumont A, Audemard-Verger A, Costa C, Bergot E, Aouba A
Service de médecine interne, CHU de Caen, Université de Caen-Normandie, avenue de la Côte-de-Nacre, 14000 Caen, France.
Service de pneumologie, CHU de Caen, Université de Caen-Normandie, Caen, France.
Rev Med Interne. 2021 Oct;42(10):734-739. doi: 10.1016/j.revmed.2021.03.002. Epub 2021 Mar 25.
Pyoderma gangrenosum (PG) is a rare, mainly dermatological condition, whose unusual and little-known lung involvement presents a diagnostic and therapeutic challenge.
A 66-year-old man, followed for 6 years for an IgA monoclonal gammopathy of undetermined significance and an initially cutaneous corticosteroid-dependent PG, received a pneumonectomy for a mass suspected of neoplasia, that turns out to be a PG pulmonary localisation. During successive pneumopathies, sometimes dyspneic and excavated, several hypotheses are discussed. Various infectious and immunological explorations, and various antibacterial/fungal or immunosuppressive therapies are conducted, to finally conclude to pulmonary and/or cutaneous recurrences of PG. The outcome at 14 months seems finally favourable with tofacitinib.
The recognition of cutaneous involvement of PG, which is essential for the diagnosis of its lung involvement, is probably the mirror of its evolution under treatment. Only multidisciplinary confrontation of reported cases will allow the elaboration of diagnostic and therapeutic recommendations.
