RESUMO
BACKGROUND: Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis often associated with systemic diseases, particularly chronic inflammatory bowel diseases. Extracutaneous manifestations (articular, ocular, renal, pulmonary, hepatosplenic, muscular) exist, with lung involvement being the most common. PATIENT AND METHODS: We report a case of PG with skin and lung involvements in a patient treated with high-dose corticosteroids in a setting of severe ulcerative colitis (UC). Lung involvement was diagnosed during the pretreatment assessment performed prior to initiation of anti-TNFα therapy. Infliximab resulted in rapid improvement of the lung and skin lesions. DISCUSSION: In the event of simultaneous cutaneous PG lesions and lung lesions suggestive of abscess, visceral involvement should be suspected. First-line treatment consists of oral corticosteroids. In our patient, the occurrence of lesions under corticosteroids in UC militated in favour of anti-TNFα therapy, which proved effective.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Colite Ulcerativa/complicações , Imunossupressores/uso terapêutico , Pneumopatias/tratamento farmacológico , Pioderma Gangrenoso/tratamento farmacológico , Adolescente , Corticosteroides/uso terapêutico , Analgésicos/uso terapêutico , Anticorpos Monoclonais/administração & dosagem , Colectomia , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/cirurgia , Terapia Combinada , Quimioterapia Combinada , Ergocalciferóis/uso terapêutico , Hemorragia Gastrointestinal/etiologia , Humanos , Imunossupressores/administração & dosagem , Infliximab , Pneumopatias/diagnóstico por imagem , Pneumopatias/etiologia , Masculino , Omeprazol/uso terapêutico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Proctite/complicações , Proctite/tratamento farmacológico , Proctite/cirurgia , Pioderma Gangrenoso/diagnóstico por imagem , Pioderma Gangrenoso/etiologia , Tomografia Computadorizada por Raios XRESUMO
Pyoderma gangrenosum is an uncommon chronic ulcerative condition, the aetiology of which is poorly understood. Ophthalmic involvement is rare. The case presented in this paper involves destruction of the orbital contents with subsequent perforation of the eye despite conventional therapy. Evisceration was performed with the patient being subjected to hyperbaric oxygen therapy pre- and post-operatively, with resultant cessation of the disease process.