Nagase Takaaki, Takakubo Yuya, Wanezaki Yoshihiro, Aso Masashi, Takagi Michiaki
Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, JPN.
Orthopaedics and Rehabilitation, Yamagata University Hospital, Yamagata, JPN.
Cureus. 2024 Dec 12;16(12):e75614. doi: 10.7759/cureus.75614. eCollection 2024 Dec.
Pyoderma gangrenosum (PG) is a rare dermatosis characterised by necrotic ulcers with a predilection mainly for the lower legs. We report a case of a 67-year-old man with PG and severe ankle ankylosis complicated by rheumatoid arthritis (RA) treated with anti-tumor necrosis factor, adalimumab (ADA). He was referred to our hospital because his right ankle showed severe ulcers and blackening. X-rays of the right ankle and foot showed bone and joint destruction with ankylosis. Initially diagnosed with stasis dermatitis, he was treated, but his condition became increasingly worse. A skin biopsy revealed neutrophilic invasion of the skin tissue, and final diagnosis was PG complicated with RA and ankylosing joint. ADA therapy improved the patient's skin condition and reduced the right ankle pain, although severe right ankle ankylosis progressed during the last follow-up. PG should be considered as a differential in patients with RA and refractory skin ulcers.
坏疽性脓皮病（PG）是一种罕见的皮肤病，其特征为坏死性溃疡，主要好发于小腿。我们报告一例67岁男性患有PG并伴有严重的踝关节强直，该患者并发类风湿关节炎（RA），接受了抗肿瘤坏死因子药物阿达木单抗（ADA）治疗。他因右踝出现严重溃疡和发黑而被转诊至我院。右踝和足部的X线检查显示骨与关节破坏并伴有强直。最初诊断为淤积性皮炎，接受了治疗，但病情日益恶化。皮肤活检显示皮肤组织有中性粒细胞浸润，最终诊断为PG合并RA及关节强直。ADA治疗改善了患者的皮肤状况并减轻了右踝疼痛，尽管在最后一次随访时严重的右踝强直仍有进展。对于患有RA和难治性皮肤溃疡的患者，应考虑将PG作为鉴别诊断之一。
