A case report of successful treatment of pyoderma gangrenosum in a patient with autoimmune hepatitis, and review of the literature.
BACKGROUND
Pyoderma Gangrenosum (PG) is a cutaneous condition, its diagnosis suggested by the presence of a painful cutaneous ulcer showing rapid progression. Pyoderma gangrenosum is associated with a concomitant systemic disease in 50 to 70 % of cases, including inflammatory bowel disease (IBD), rheumatoid arthritis, and lymphoproliferative disorders. Although PG has also been reported with viral hepatitis, it is rarely associated with autoimmune hepatitis.


METHODS
A 19-year-old Caucasian female, with a prior diagnosis of autoimmune hepatitis (AIH) in remission, presented with bilateral lower limb ulcers 4 years after the diagnosis of AIH. She was diagnosed with PG and treated with high-dose prednisolone, methotrexate and cyclosporine. One year later she was well, the ulcers completely healed, and with the autoimmune hepatitis still in remission.


CONCLUSIONS
We report a case of autoimmune hepatitis and the subsequent, rarely occurring, extra-hepatic onset of pyoderma gangrenosum, with the AIH in remission, strengthening the association between the two conditions. Since both the AIH and the PG can present serious diagnostic challenges, thus delaying vital therapy, it is important that the development of either prompts us to consider the possibility of the other developing in the future or if already present facilitate its diagnosis, such considerations making the case for a systematic follow up.
Pathophysiology Department, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece. T_Androutsakos@yahoo.gr.
Theodoros
T
Androutsakos
Second Department of Propedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece. pstamop@gmail.com.
Paraskevas
P
Stamopoulos
Department of Dermatopathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece. aroniki@med.uoa.gr.
Kiriaki
K
Aroni
Pathophysiology Department, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece. grhatzis@med.uoa.gr.
Gregorios
G
Hatzis
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D016572:Cyclosporine / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications*; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D017511:Pyoderma Gangrenosum / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D003879:Dermatologic Agents; D016572:Cyclosporine; D011239:Prednisolone; D008727:Methotrexate