David Filipa, Lopes Freitas Rafaela, Brás-Cruz Rute, Rocha Joana, Rosário Cristina
Internal Medicine, Department of Medicine, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, PRT.
Dermatology, Department of Medicine, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, PRT.
Cureus. 2022 May 18;14(5):e25112. doi: 10.7759/cureus.25112. eCollection 2022 May.
Pyoderma gangrenosum (PG) is a rare chronic neutrophilic dermatosis that can be associated with underlying conditions, such as inflammatory bowel disease and neoplasms, or can be idiopathic. Classically, it presents as painful skin lesions. We present a case of a 54-year-old woman who got a synovial cyst removed from her left hand, which later aggravated into a non-healing wound, and subsequently a painful necrotic ulcer. The histological pattern combined with the clinical features suggested PG. General wound care was performed, associated with topical tacrolimus and oral corticotherapy with a good response. Three similar episodes with lesions scattered over the body followed and required a combination of other pharmacological alternatives. An extensive etiological study was carried out to screen secondary causes without any relevant findings. Therefore, an idiopathic relapsing PG was assumed. PG is poorly understood, underdiagnosed and hard to treat. It has a clear impact on the quality of life of the patient, so high suspicion and timely treatment are essential to minimize complications.
坏疽性脓皮病（PG）是一种罕见的慢性嗜中性皮病，可与潜在疾病相关，如炎症性肠病和肿瘤，也可为特发性。典型表现为疼痛性皮肤病变。我们报告一例54岁女性，其左手滑膜囊肿切除术后伤口恶化，形成不愈合创面，随后发展为疼痛性坏死溃疡。组织学表现结合临床特征提示为PG。给予一般伤口护理，并外用他克莫司及口服皮质类固醇治疗，效果良好。随后又出现3次类似发作，皮损散在全身，需要联合使用其他药物。进行了广泛的病因学研究以筛查继发原因，但未发现相关结果。因此，考虑为特发性复发性PG。PG的发病机制尚不清楚，易漏诊且治疗困难。它对患者的生活质量有明显影响，因此高度怀疑并及时治疗对于减少并发症至关重要。
