Cavitary pyoderma gangrenosum treated with local infusion of corticosteroid.
BACKGROUND
Pyoderma gangrenosum (PG) is a rare inflammatory skin condition, characterized by progressive and recurrent skin ulceration, often representing a pathergy response.


METHODS
We report a case of spontaneous retrosternal PG that developed on the background of previous PG of the skin of the back. The patient had underlying ulcerative colitis. After failure of prednisone, minocycline, and dapsone, a novel method was instituted. Local flushing with dexamethasone, by a radiologically inserted retrosternal catheter with precordial suction, induced a rapid and sustained response. Subsequently maxillary sinus PG developed after the patient's tooth extraction. This responded to local corticosteroid injections in combination with systemic corticosteroid.


CONCLUSIONS
Further reports of this technique are required to consolidate its use and infusion variables.


CONCLUSIONS
Two unusual sites of PG have been described, with successful treatment by a novel local steroid infusion. The profound sensitivity to trauma is demonstrated, which suggests that prophylactic corticosteroid may be useful for essential surgical intervention.
Tallon
Ben
B
Department of Dermatology, Waikato Hospital, Hamilton, New Zealand. bentallon@gmail.com
Rademaker
Marius
M
Parkinson
Grant
G
Whitley
Brian
B
Swarbrick
Michael J
MJ
D001707:Biopsy, Needle; D003907:Dexamethasone / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D036502:Infusions, Intralesional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017511:Pyoderma Gangrenosum / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D012008:Recurrence; D012720:Severity of Illness Index; D012883:Skin Ulcer / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D035441:Thoracic Wall; D016896:Treatment Outcome
D003907:Dexamethasone