The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

Pyoderma Gangrenosum in Ulcerative Colitis

A B

A
71-year-old man with a 5-year history of glucocorticoid- Giovanni Perricone, M.D.
dependent ulcerative colitis presented to the gastroenterology clinic with Marcello Vangeli, M.D.
painful, rapidly progressive ulcerative lesions involving the left chest Azienda Socio Sanitaria Territoriale Grande
(Panel A) and leg (Panel B). The physical examination revealed skin ulcerations Ospedale Metropolitano Niguarda
with a purulent base and an irregular purple edge. The histopathological examina- Milan, Italy
giovanniperricone@gmail.com
tion of an incisional biopsy sample obtained from the chest lesion showed epider-
mal and superficial dermal necrosis with an underlying mixed inflammatory-cell
infiltrate, abscess formation, and leukocytoclastic vasculitis. Direct microbiologic
examination and cultures were negative for bacterial, fungal, and atypical myco-
bacterial pathogens. A diagnosis of pyoderma gangrenosum was made. Pyoderma
gangrenosum is an ulcerating, inflammatory skin disorder that can be associated
with an underlying systemic disease, such as ulcerative colitis. The condition is the
second most common dermatologic manifestation of inflammatory bowel disease
after erythema nodosum. The patient was treated with infliximab at weeks 0, 2,
and 6 and then every 8 weeks. After 3 months, there was complete resolution of
the skin lesions and remission of the ulcerative colitis.
DOI: 10.1056/NEJMicm1802201
Copyright © 2018 Massachusetts Medical Society.

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