RESUMO
Pyoderma gangrenosum (PG) is a rare neutrophilic inflammatory skin disease. Systemic corticosteroid and immunosuppressive agents are the mainstay treatment. PG usually precludes a surgical approach due to pathergy phenomenon. Recent literatures show skin grafting and negative pressure wound therapy are safe if performed under adequate immunosuppression. We present a case of a 61-year-old male patient suffered from PG induced left posterior leg wound with Achilles tendon exposure. We made timely diagnosis and treated him with adequate immunosuppression therapy followed by perforator propeller flap for wound coverage. This case report emphasizes the need for high index of suspicion for PG diagnosis. Furthermore, with adequate immunosuppression, operative intervention may not be an absolute contraindication for PG.
RESUMO
Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis, characterized by painful ulcerative, bullous, or pustular skin conditions. Pathergy is usually used to describe PG which refers to initiation or exacerbation of the disease after accidental or iatrogenic skin trauma. Diagnosis of postoperative PG is challenging not only due to its presentation mimics infectious wounds, but also because there are no standard laboratory parameters for diagnosis. Herein, we present a case of a 46-year-old female patient who had recurrent bilateral breast wound erythema, swelling, pain and necrosis after breast reduction mammoplasty at Centro Hospitalar Conde São Januário Macau SAR in 2018. We diagnosed her postoperative PG and successfully treated her with oral prednisolone with significant therapy response.
RESUMO
Immunoglobulin G4-related disease (IgG4-RD) is a systemic immune-mediated fibroinflammatory condition characterized by tumefactive lesions that can affect multiple organs. Serum IgG4 levels may be elevated. Early recognition is sometimes difficult but is important to avoid irreversible organ damage. We describe the case of a 28-year-old male patient who presented with a 2-year history of recurrent low-grade fever, night sweats and non-specific manifestations. We eventually diagnosed IgG4-related aortitis by PET-CT scan. The patient was successfully treated with prednisolone and mycophenolate mofetil with complete clinical and radiological resolution. LEARNING POINTS: IgG4-related disease is a systemic immune-mediated disease that can affect many organs and systems.Aortitis can be one of the differential diagnoses in patients with fever of unknown origin, back pain and other unspecific symptoms.Delayed diagnosis and treatment may cause major complications or irreversible damage, so timely diagnosis and appropriate treatment is very important.