Ogata Yudai, Soeda Atsuko, Saura Isao, Nemoto Emi, Tange Yoshitaka, Enami Chiaki, Ochi Daisuke, Dai Yuichi, Akiyama Shintaro, Ikezawa Kazuto
Division of Gastroenterology, Tsukuba Memorial Hospital.
Division of Diagnostic Pathology, Tsukuba Memorial Hospital.
Nihon Shokakibyo Gakkai Zasshi. 2024;121(6):481-488. doi: 10.11405/nisshoshi.121.481.
Pyoderma gangrenosum (PG) is a sterile inflammatory skin condition that is frequently associated with immune-related diseases, including inflammatory bowel disease (IBD). PG causes noninfectious ulcers. Facial PG is uncommon while PG usually occurs on the trunk and lower limbs. Herein, we report a case of a male teenager with fever, pustules, ulcers, and necrosis on both cheeks. He was initially diagnosed with complicated acne with bacterial infection, but the condition progressed to subcutaneous ulcers despite treatment. Biopsy revealed inflammatory lesions in dermal and subcutaneous tissue with neutrophil infiltration, consistent with PG. Although lacking typical IBD symptoms, blood tests revealed anemia and positive fecal occult blood. Sigmoidoscopy revealed inflammation, ulcers, and pseudopolyps in the colon and rectum, thereby diagnosing ulcerative colitis (UC). After treating PG and UC with prednisolone and skin grafts, golimumab was prescribed. The patient is now in remission. Necrotic tissue buildup can complicate closure in PG cases;this emphasizes the need for effective IBD treatment to facilitate procedures such as skin grafts.
坏疽性脓皮病（PG）是一种无菌性炎症性皮肤病，常与免疫相关疾病有关，包括炎症性肠病（IBD）。PG会导致非感染性溃疡。面部PG并不常见，而PG通常发生在躯干和下肢。在此，我们报告一例男性青少年病例，其双颊出现发热、脓疱、溃疡和坏死。他最初被诊断为伴有细菌感染的复杂性痤疮，但尽管接受了治疗，病情仍发展为皮下溃疡。活检显示真皮和皮下组织有炎症性病变，伴有中性粒细胞浸润，符合PG表现。尽管缺乏典型的IBD症状，但血液检查显示贫血且粪便潜血呈阳性。乙状结肠镜检查显示结肠和直肠有炎症、溃疡和假息肉，从而诊断为溃疡性结肠炎（UC）。在用泼尼松龙和皮肤移植治疗PG和UC后，开始使用戈利木单抗。患者目前处于缓解期。在PG病例中，坏死组织堆积会使伤口闭合复杂化；这强调了有效治疗IBD以促进诸如皮肤移植等手术的必要性。
