title: Atypical presentation of pioderma gangrenosum complicating ulcerative colitis: rapid disappearance with methylprednisolone.
abstract: Pioderma gangrenosum (PG) is an uncommon ulcerative cutaneous dermatosis associated with a variety of systemic diseases, including inflammatory bowel disease (IBD), arthritis, leukaemia, hepatitis, and primary biliary cirrhosis. Other cutaneous ulceration resembling PG had been described in literature. There has been neither laboratory finding nor histological feature diagnostic of PG, and diagnosis of PG is mainly made based on the exclusion criteria. We present here a patient, with ulcerative colitis (UC) who was referred to the emergency section with a large and rapidly evolving cutaneous ulceration. Laboratory and microbiological investigation associated with histological findings of the ulcer specimen allowed us to exclude autoimmune and systemic diseases as well as immuno-proliferative disorders. An atypical presentation of PG with UC was diagnosed. Pulse boluses of i.v. methyl-prednisolone were started, and after tapering steroids, complete resolution of the skin lesion was achieved in 3 wk. The unusual rapid healing of the skin ulceration with steroid mono-therapy and the atypical cutaneous presentation in this patient as well as the risk of misdiagnosis of PG in the clinical practice were discussed.
authors.affiliation: Liver Transplantation Center, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, Milan, Italy. paoloaseni@gmail.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Aseni
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Sandro
authors.forename: Plamen
authors.initials: P
authors.lastname: Mihaylov
authors.forename: Luca
authors.initials: L
authors.lastname: Lamperti
authors.forename: Luciano-Gregorio
authors.initials: LG
authors.lastname: De Carlis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003093:Colitis, Ulcerative / Q000150:complications*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D017511:Pyoderma Gangrenosum / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D008775:Methylprednisolone