ABSTRACT
Peristomal pyoderma gangrenosum (PPG), a variant of pyoderma gangrenosum, occurs adjacent to intestinal or urinary stomas and are typically seen in patients with active inflammatory bowel diseases (IBD). The present study evaluated 14 cases of PPG among 537 patients that had undergone ostomy surgery at Asahikawa Medical University Hospital from January 2017 to December 2021. The incidence of PPG among ostomy cases was calculated as 1.01 per 100-person-years. The median period from ostomy surgery to PPG onset was 192.5 days (36-1224 days). Significant differences in gender and ostomy subtype were observed in patients with PPG compared to all patients that had undergone ostomy surgery. IBD prevalence was comparable between groups. Topical corticosteroids or tacrolimus were sufficient for controlling PPG lesions in all cases other than one case controlled with oral prednisolone administered for a separate condition. Clinicians should be aware of recent developments in IBD therapies that may modify the risk of developing PPG. The present study results add to current knowledge of the pathogenesis of PPG.
Subject(s)
Inflammatory Bowel Diseases , Pyoderma Gangrenosum , Surgical Stomas , Humans , Pyoderma Gangrenosum/drug therapy , Retrospective Studies , Inflammatory Bowel Diseases/complications , Tacrolimus/therapeutic useSubject(s)
Benzoates/adverse effects , Hydrazines/adverse effects , Ischemia/etiology , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Pyrazoles/adverse effects , Thrombosis/chemically induced , Aged , Biopsy , Clopidogrel/therapeutic use , Computed Tomography Angiography , Conservative Treatment , Female , Humans , Hyperbaric Oxygenation , Ischemia/pathology , Ischemia/therapy , Platelet Count , Purpura, Thrombocytopenic, Idiopathic/blood , Skin/blood supply , Skin/diagnostic imaging , Skin/pathology , Thrombosis/complications , Thrombosis/diagnosis , Thrombosis/drug therapy , Tibial Arteries/diagnostic imaging , Tibial Arteries/pathology , Toes/blood supply , Toes/diagnostic imaging , Toes/pathology , Treatment Outcome , Warfarin/therapeutic useABSTRACT
Anti-tumor necrosis factor α (TNF-α) biologic agents are used for treating refractory sarcoidosis. However, sarcoidosis-like epithelioid cell granulomas may develop during anti-TNF-α treatment. A 63-year-old man suffering from rheumatoid arthritis was treated with oral methotrexate and methylprednisolone for 4 years. He subsequently started biweekly subcutaneous injections of certolizumab pegol. Three months later, light red follicular papules developed on his chest and they spread over the trunk and bilateral upper arms. Histopathology of a lesion showed a sharply demarcated noncaseating epithelioid cell granuloma with multi-nucleated giant cells in the upper perifollicular area. The follicular papules subsided following discontinuation of certolizumab pegol. Folliculitis-like lichenoid sarcoidosis should be included among the adverse cutaneous reactions of anti-TNF-α treatment.
ABSTRACT
Although vascular complications induced by acute aortic dissection are varied and common, gallbladder necrosis induced by acute aortic dissection is rare. We experienced the case of a 42-year-old woman who suffered from acute gallbladder necrosis that occurred the following day after the onset of acute type B aortic dissection. Contrasted computed tomography, which showed the thickened wall of the gallbladder and the pericholecystic fluid, as well as the occluded celiac artery, was an effective diagnostic procedure. We performed cholecystectomy and revascularization of the celiac artery using autologous saphenous vein. Her postoperative course was uneventful, and she was discharged after 20 postoperative days.
