Authors: Mary Rose Lim-del Mindo MD, DPDS and Daisy King-Ismael MD, FPDS

Abstract

Pyoderma gangrenosum (PG) is a rare, inflammatory, ulcerative skin condition characterized by an ulcer with advancing violaceous border, negative cultures, unresponsiveness to antibiotics, the phenomenon of pathergy and histopathology showing neutrophilic infiltration. It usually occurs in all age groups but is rare among infants and very young children. A 6-month-old boy presented with papules which evolved into necrotic ulcers on the ears, perioral area, nose, neck, inguinal, scrotal, intergluteal and genital areas. The destruction of the ear cartilage made the clinical picture unusual and to the best of our knowledge, has rarely been reported as a feature of pyoderma gangrenosum in published case reports. The patient responded well to Hydrocortisone IV and tapering doses of oral prednisone. The long term effects in patients who developed infantile PG are still unknown and further follow-up of these unusual cases is recommended.

Citation

Lim-del Mindo, MR & King-Ismael, D. (2017). Mutilating pyoderma gangrenosum in an infant: A case report. Journal of the Philippine Dermatological Society, 26(1), 62-64.

Keywords

Pyoderma Gangrenosum, neutrophilic dermatosis, pediatric dermatology

1. Kechichian E, Haber R, Mourad N. Pediatric pyoderma gangrenosum: a systematic review and update. Int J Dermatol. 2017; 56:486-495.
2. Mc Aleer M, Powell F, Devaney D, O’Donell B. Infantile pyoderma gangrenosum. J Am Acad Dermatol. 2008; 58:S23-8.
3. Powell F, Hackett B. Pyoderma gangrenosum. In: Wolff K, Goldsmith L, Katz S, Gilchrest B, Paller A, Lefell D, eds. Fitzpatrick’s Dermatology in General Medicine. 7th ed. New York: Mc Graw-Hill Co. Inc. 2008; 296-302.
4. Bhat R, Shetty S, Kamath G. Pyoderma gangrenosum in childhood. Int J Dermatol 2004; 43:205-207.
5. Callen J. Seminar: Pyoderma gangrenosum. Lancet. 1998; 351:581-85.
6. Ahmadi S, Powell F. Pyoderma gangrenosum: uncommon presentations. Clin Dermatol. 2005; 23:612-620.
7. Miller J, Yentzer B, Clark A, Jorizzo J, Feldman S. Reviews: Pyoderma gangrenosum: A review and update on new therapies. J Am Acad Dermatol. 2010; 62:646-54.
8. Maverakis E, Fung MA, Lynch PJ, Draznin M, Michael DJ, Ruben B, Fazel N. Review: Acrodermatitis enteropathica and an overview of zinc metabolism. J Am Acad Dermatol. 2007; 56:116-24.
9. Zanto SN, Montana H. Changing algorithms in syphilis laboratory diagnosis. Elsevier Clinical Microbiology Newsletter. 2010; 32:8:59-64.
10. Peter C, Thompson M, Wilson D: False-positive reactions in the rapid plasma reagin-card, fluorescent treponemal antibody-absorbed, and hemagglutination treponemal syphilis serology Tests. J Clin Microbiol. 1979; 9(3):369-372.
11. Magro C, Crowson A, Dyrsen M, Mihm Jr, M, Cutaneous manifestations of nutritional deficiency states and gastrointestinal disease. In: Elder D, et al. Lever’s Histopathology of the Skin. 10th ed. Philadelphia: Lippincott Williams & Wilkins. 2009; 411-412.
12. Reichrath J, Bens G, Bonowitz A, Tilgen W. Clinical Review: Treatment recommendations for pyoderma gangrenosum: An evidence-based review of the literature based on more than 350 patients. J Am Acad Dermatol 2005; 53:273-83.

More Articles