Chronic Non-Healing Wounds in Children: What Lies Beneath? A Case of Pediatric Pyoderma Gangrenosum in a 14 year-old Male: A Diagnostic and Treatment Challenge

Authors: Margaret Stephanie L. Jimenez MD, Michaela M. Tabalon, MD, Maria Vinna N. Crisostomo, MD, Jennifer Aileen A. Tangtatco MD,DPDS,CWSP

Abstract

Introduction: Pyoderma gangrenosum (PG) is a rare neutrophilic disease. Its etiology remains unknown. Incidence is estimated at 3-10 patients per million per year. It is rarely seen in the pediatric population. A painful rapidly enlarging ulcer with a violaceous, undermined, and well-defined border containing granulation tissue, blood and purulent exudate is the hallmark of classical or ulcerative PG. A delay or miss in diagnosis of PG is not uncommon especially for pediatric patients due to its rare occurrence.

Case Summary: We present a case of a 14-year-old male with recurrent and progressively growing ulcers on both lower extremities previously managed as pyogenic infection and treated with antibiotics with no improvement. Further evaluation and repeated biopsies has led to the diagnosis of Pyoderma Gangrenosum. The patient was successfully treated with topical and systemic steroids as well as adjunctive dapsone therapy. In addition, wound care and regular follow up were implemented and, in a 17 month follow up, complete healing of the lesions was noted.

Conclusion: PG is a rare disease, which poses a diagnostic and therapeutic challenge as it masquerades as different skin conditions. It is rarely seen in children but must be highly suspected in the setting of chronic non-healing wound. Early recognition is of utmost importance as it leads to proper treatment, prevents rapid progression and improves disease outcomes.

 

Citation

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Keywords

Pyoderma gangrenosum, pediatric dermatology, dapsone

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