Adams Jennifer, Habenicht Daniel, Gibran Yaman
University of Texas Rio Grande Valley - School of Medicine, 1201 W University Dr, Edinburg, TX, USA.
Department of Internal Medicine, University of Texas Rio Grande Valley, Valley Baptist Medical Center, Harlingen, TX, USA.
Ann Med Surg (Lond). 2022 Jun;78:103828. doi: 10.1016/j.amsu.2022.103828. Epub 2022 May 18.
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis of non-infectious etiology. Cocaine-induced PG (CIPG) is a documented clinical variant.
We report an exceptional case of cocaine-induced PG flare unresponsive to conventional treatment in the context of positive COVID status. A 41year-old male with past medical history of recent COVID infection, pyoderma gangrenosum and chronic cocaine abuse presented with acutely worsening multifocal ulcerations covering multiple limbs approximately 30% body surface area (BSA) one day after cocaine use. After hospitalization for ten days with no improvement in cutaneous symptoms, he was transferred to a burn center for disease control with biologics.
The previous temporal relationship between disease outbreak and cocaine consumption and improvement after its discontinuation no longer remained in the setting of COVID positive status. This is the first case in literature of extensive and treatment-refractory PG in a COVID-positive patient with recent cocaine use.
This case highlights the importance of further investigation on the connection between COVID infection and PG and the need for establishing treatment guidelines for PG.
坏疽性脓皮病（PG）是一种病因非感染性的罕见嗜中性皮病。可卡因诱发的PG（CIPG）是一种有文献记载的临床变体。
我们报告了一例在新冠病毒检测呈阳性的情况下，对常规治疗无反应的可卡因诱发的PG病情加重的特殊病例。一名41岁男性，既往有近期新冠病毒感染、坏疽性脓皮病和慢性可卡因滥用病史，在使用可卡因一天后，出现急性加重的多灶性溃疡，累及多个肢体，约占体表面积（BSA）的30%。住院十天后皮肤症状无改善，遂转至烧伤中心使用生物制剂控制病情。
在新冠病毒检测呈阳性的情况下，先前疾病发作与可卡因使用之间的时间关系以及停用可卡因后的改善情况已不复存在。这是文献中首例近期使用可卡因的新冠病毒检测呈阳性患者出现广泛且治疗难治性PG的病例。
本病例凸显了进一步研究新冠病毒感染与PG之间联系的重要性，以及制定PG治疗指南的必要性。
