title: ﻿﻿﻿﻿﻿﻿Diagnosis and Treatment of Type II Necrotizing Fasciitis in a Child Presenting With a Minor Abrasion, Edema, and Apparent Bruising ﻿﻿﻿﻿﻿﻿﻿﻿.
abstract: ﻿ ﻿Pyoderma gangrenosum (PG) is associated with systemic disease, mostly rheumatoid arthritis (RA) and inflammatory bowel disease (IBD), in many patients (more than 50%). Lesions associated with arthritis are often ulcerative. Although these lesions typically affect the lower limbs, they can also affect the entire body. Successful therapy involving monoclonal antibodies seems to favor an autoimmune etiopathogenesis that has disorders of neutrophils' chemotactic activity and interleukins, which are acted upon by TNF-α cytokines. The ulcers grow rapidly, exacerbate after trauma, and necrosis can invade each skin layer up to the fascia. Therefore, debridement is contraindicated because it introduces the so-called "pathergy" mechanism. The diagnosis is quite difficult and is often made late due to the lack of indicative clinical and laboratory findings. The following is a report of a case of multiple, ulcerative, PG ulcers induced by arthritis. The ulcers occurred over several occasions with large and aggressive necrosis reaching the osseous plane in the heel and elbow. The high IgE values (between 2000 UI/mL and 3000 UI/mL) suggested that a type I immunitary reaction, such as in-skin anaphylaxis, was involved. Nevertheless, the antigen remains unknown and the genesis may be multifactorial. A corticosteroid (prednisolone) was the first-line systemic treatment used in this case and caused rapid improvement. Further investigations will be necessary to understand the meaning of this immunologic disorder ﻿﻿﻿.
authors.affiliation: Department of Hyperbaric Medicine, Intermountain Dixie Regional Health Center, St. George Utah; Email: lveggert@msn.com.
authors.forename: Joan
authors.initials: J
authors.lastname: Eggert
authors.forename: Adriana
authors.initials: A
authors.lastname: Di Giacomo
authors.forename: Pier
authors.initials: P
authors.lastname: Paolo Vergineo