(Last Updated On: December 1, 2021)
Ria Carla C. Siccion, MD and Arnelfa C. Paliza, MD, FPDS
University of Santo Tomas Hospital, España, Manila
Department of Dermatology

Abstract

Introduction: Superficial granulomatous pyoderma is a rare superficial variant of pyoderma gangrenosum. With
clinical and histological features that mimic infectious processes, misdiagnosis is common. This report aims to
present a rare, often overlooked disease, highlighting the need for timely histopathologic diagnosis to prevent
unnecessary treatment and morbidity.

Case: Patient is a 42-year-old female with recurrent painful ulcers on her right leg. Initial histopathology was
interpreted as granulomatous dermatitis secondary to cutaneous tuberculosis and was managed with anti-Koch’s
regimen for six months. However, the ulcers worsened, which led to right leg amputation. New similar ulcers
eventually recurred over the other extremities where repeat biopsy have shown neutrophilic dermatosis with a
three-layer granuloma that is distinctive for superficial granulomatous pyoderma. Patient was treated with oral
corticosteroids which was effective in controlling the disease.

Conclusion: This report documents a rare case of superficial granulomatous pyoderma presenting as non-healing
ulcer, previously misdiagnosed and treated with unwarranted surgery and anti-microbials. The awareness of the characteristic clinical and histopathological features is essential for diagnosis so as to provide rapid disease control
and avoid potentially aggravating management.

Keywords

Pyoderma gangrenosum, superficial granulomatous pyoderma, cutaneous tuberculosis

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