Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Sep 21, 2008; 14(35): 5471-5473
Published online Sep 21, 2008. doi: 10.3748/wjg.14.5471
Atypical presentation of pioderma gangrenosum complicating ulcerative colitis: Rapid disappearance with methylprednisolone
Paolo Aseni, Stefano Di Sandro, Plamen Mihaylov, Luca Lamperti, Luciano Gregorio De Carlis
Paolo Aseni, Stefano Di Sandro, Plamen Mihaylov, Luca Lamperti, Luciano Gregorio De Carlis, Liver Transplantation Center, Niguarda Ca’ Granda Hospital, Milan 20162, Italy
Author contributions: Aseni P, Di Sandro S, Mihaylov P, Lamperti L, De Carlis LG contributed equally to this work.
Correspondence to: Paolo Aseni, MD, Liver Transplantation Center, Niguarda Ca’ Granda Hospital, Ospedale Maggiore 3, Milan 20162, Italy.
Telephone: +38-2-64442252 Fax: +39-2-64442893
Received: June 3, 2008
Revised: July 28, 2008
Accepted: August 3, 2008
Published online: September 21, 2008

Piodermal gangrenosum (PG) is an uncommon ulcerative cutaneous dermatosis associated with a variety of systemic diseases, including inflammatory bowel disease (IBD), arthritis, leukaemia, hepatitis, and primary biliary cirrhosis. Other cutaneous ulceration resembling PG had been described in literature. There has been neither laboratory finding nor histological feature diagnostic of PG, and diagnosis of PG is mainly made based on the exclusion criteria. We present here a patient, with ulcerative colitis (UC) who was referred to the emergency section with a large and rapidly evolving cutaneous ulceration. Laboratory and microbiological investigation associated with histological findings of the ulcer specimen allowed us to exclude autoimmune and systemic diseases as well as immuno-proliferative disorders. An atypical presentation of PG with UC was diagnosed. Pulse boluses of i.v. methyl-prednisolone were started, and after tapering steroids, complete resolution of the skin lesion was achieved in 3 wk. The unusual rapid healing of the skin ulceration with steroid mono-therapy and the atypical cutaneous presentation in this patient as well as the risk of misdiagnosis of PG in the clinical practice were discussed.

Keywords: Ulcerative colitis, Pioderma gangrenosum, Steroids, Cutaneous lesion, Immunosuppression