title: A case of malignant pyoderma with neurological manifestations.
abstract: A case of malignant pyoderma with a fatal course is presented. A 62-year-old Chinese man was admitted with a 8-month history of progressive ulcerative nodular skin lesions starting on the right antecubital fossa and spreading to the chest, face, arms and legs. The lesions failed to respond to many antibiotics. Examination revealed multiple large crusted foul-smelling ulcers with erythematous raised vegetative edges and tender erythematous nodules. Investigations showed an anaemia of chronic disease and an erythrocyte sedimentation rate of 135mm/1st hour. Histology showed multiple circumscribed microabscesses in the upper dermis. The skin lesions responded well to systemic corticosteroid therapy. Three months after admission, he developed multiple cranial nerve palsies, and severe progressive peripheral neuropathy. Radiographic studies revealed cavitating lesion in the right upper lobe consistent with a diagnosis of carcinoma of the lung. Five months after admission, patient was intubated for stridor but he succumbed to aspiration pneumonia. Malignant pyoderma should be considered if an ulcer fails to respond to antibiotics, and possible neurological complications should be thought of.
authors.affiliation: Middle Road Hospital, Singapore.
authors.forename: C T
authors.initials: CT
authors.lastname: Lee
authors.forename: T
authors.initials: T
authors.lastname: Thirumoorthy
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002277:Carcinoma / Q000150:complications; D003389:Cranial Nerve Diseases / Q000209:etiology*; D006319:Hearing Loss, Sensorineural / Q000209:etiology*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000209:etiology*; D011239:Prednisolone / Q000627:therapeutic use; D011711:Pyoderma / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D012883:Skin Ulcer / Q000150:complications* / Q000188:drug therapy / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D011239:Prednisolone