title: Pyoderma gangrenosum associated with nasal septal perforation, oropharyngeal ulcers and IgA paraproteinemia.
abstract: We report a case of pyoderma gangrenosum (PG) associated with nasal septal perforation, pharyngeal ulcers and IgA paraproteinemia. A 28-year-old woman first developed painful undermined ulcers on her perianal, inguinal and axillary areas when she was 22 years old. Histological findings from the cutaneous ulcers showed dermal and epidermal infiltrate of neutrophils, which was compatible with PG. Laboratory examinations did not detect any associations of systemic diseases other than polyclonal IgA paraproteinemia. Nasal fiberscopy revealed septal perforation and multiple ulcers on her pharynx. The biopsy specimen from the pharyngeal ulcers showed a polymorphous cellular infiltrate without necrotizing vasculitis or granuloma. However, there were no atypical lymphocytes that are typically seen in nasal NK/T lymphoma. By immunohistochemical analysis, the infiltrated lymphocytes were proved to be T cells and Epstein-Barr virus encoded RNA (EBER) was not detected. No pulmonary or renal lesions resembling Wegener's granulomatosis were found. Taken together, the nasal septal perforation was considered as nasal involvement of PG.
authors.affiliation: Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
authors.forename: Iwao
authors.initials: I
authors.lastname: Isomura
authors.forename: Saori
authors.initials: S
authors.lastname: Miyawaki
authors.forename: Akimichi
authors.initials: A
authors.lastname: Morita
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D003131:Combined Modality Therapy; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007150:Immunohistochemistry; D007564:Japan; D009300:Nasal Septum / Q000473:pathology*; D009668:Nose Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D009960:Oropharynx / Q000473:pathology; D010612:Pharyngitis / Q000150:complications / Q000473:pathology* / Q000628:therapy; D017511:Pyoderma Gangrenosum / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D018570:Risk Assessment; D012720:Severity of Illness Index; D014456:Ulcer / Q000150:complications / Q000473:pathology* / Q000628:therapy
chemical_list: D007070:Immunoglobulin A