RESUMO
Pyoderma gangrenosum (PG) is a rare pustular and ulcerative inflammatory disease belonging to the group of neutrophilic dermatoses. It is frequently associated with systemic immune diseases. In this context the PG can be exceptionally triggered by tissue trauma such as surgery (pathergy). We report the case of a patient with stabilized rheumatoid arthritis who developed aggressive and disseminated PG at all surgical wounds following an abdominal dermolipectomy associated with breast pexy. Systemic corticosteroid methylprednisolone allowed a rapid control of skin ulcerations. In the aftermath of an intervention, PG is often confused with a bacterial skin-necrotizing panniculitis. The recognition of the inflammatory nature of cutaneous symptoms is crucial to quickly start an immunosuppressive treatment and limit scarring sequelae. Our case also illustrates the need to consider any history of dysimmune inflammatory or oncohematological disease as a risk factor before surgery, even if the latter are stabilized.
Le Pyoderma gangrenosum (PG) est une pathologie inflammatoire pustuleuse et ulcérative rare appartenant au groupe des dermatoses neutrophiliques. Elle est fréquemment associée à une maladie systémique dysimmunitaire. Dans ce contexte, le PG peut être exceptionnellement déclenché par un traumatisme tissulaire tel qu'une intervention chirurgicale (pathergie). Nous rapportons le cas d'une patiente atteinte de polyarthrite rhumatoïde peu active, mais ayant développé un PG agressif et disséminé au niveau de toutes les plaies opératoires à la suite d'une dermolipectomie abdominale associée à une pexie mammaire. Une corticothérapie systémique à base de méthylprednisolone a permis un contrôle rapide des ulcérations cutanées. En post-opératoire, le PG est très souvent confondu avec une dermo-hypodermite bactérienne nécrosante. La reconnaissance du caractère inflammatoire de la symptomatologie cutanée est cruciale afin d'entamer rapidement un traitement immunosupresseur et de limiter les séquelles cicatricielles. Notre cas clinique illustre aussi la nécessité de prendre en compte les antécédents de pathologies dysimmunitaires inflammatoires ou onco-hématologiques comme facteurs de risque avant toute intervention chirurgicale, même si ces dernières sont stabilisées et peu actives.
Assuntos
Complicações Pós-Operatórias , Pioderma Gangrenoso/etiologia , Artrite Reumatoide/complicações , Feminino , Glucocorticoides/uso terapêutico , Humanos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Pioderma Gangrenoso/tratamento farmacológicoRESUMO
The incidence of non tuberculosis mycobacterial (NTM) pulmonary diseases is increasing. Patients with NTM disease usually suffer prolonged periods of clinical illness prior to diagnosis. An etiological treatment, initiated by a well informed clinician and based on presumptive evidence, can be successful in a significant proportion of cases.
Assuntos
Pneumopatias/microbiologia , Infecções por Mycobacterium não Tuberculosas/patologia , Mycobacterium kansasii , Infecções Respiratórias/microbiologia , Humanos , Pneumopatias/diagnóstico por imagem , Pneumopatias/patologia , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/diagnóstico por imagem , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium kansasii/isolamento & purificação , Radiografia TorácicaRESUMO
We report a fatal methanol intoxication and discuss its physiopathology, diagnosis and treatment.