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1.
J Wound Ostomy Continence Nurs ; 48(5): 460-462, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34495940

RESUMO

BACKGROUND: Peristomal pyoderma gangrenosum (PPG) is a variant of pyoderma gangrenosum (PG). It results from a pathergy response to trauma from effluent from the ostomy or secondary to trauma caused by removal of the ostomy appliance adhesive in contact with the skin. Currently, no evidence-based guidelines for the management of PPG exist. This case study reports a dramatic response to crushed corticosteroid tablets in a patient who proved refractory to first- and second-line treatments of her PPG and several surgeries. CASE: Ms T. was a 39-year-old woman with Crohn's disease who underwent several ileostomies, developed PPG, and failed treatment with adalimumab. Her PPG was successfully treated topically with crushed prednisone tablets. CONCLUSION: We found that crushed corticosteroid tablets were an effective treatment of PPG, due to the ability to reduce pain and allow adhesion of the ostomy appliance.


Assuntos
Estomia , Pioderma Gangrenoso , Corticosteroides , Adulto , Feminino , Humanos , Ileostomia/efeitos adversos , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/etiologia , Comprimidos
2.
Acta Chir Plast ; 63(2): 69-72, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34404220

RESUMO

BACKGROUND: Pyoderma gangrenosum (PG) is a rare non-infectious inflammatory disease of unknown etiology that affects the skin and mucous membranes. The occurrence of pyoderma gangrenosum after a reduction mammoplasty is a very rare complication, which at first glance may seem like an infectious complication; in reality, however, it is an inflammatory disease. CASE: This case report describes a rare postoperative complication - pyoderma gangrenosum and its appropriate treatment in our patient who underwent reduction mammoplasty. CONCLUSION: Early detection of this complication is essential for the patients recovery because the primary surgical treatment can lead to worsening of the condition and is therefore contraindicated in such a case. Pyoderma gangrenosum must be treated conservatively with corticosteroids.


Assuntos
Mamoplastia , Pioderma Gangrenoso , Feminino , Humanos , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Pioderma Gangrenoso/etiologia
3.
Curr Sports Med Rep ; 20(7): 359-365, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34234091

RESUMO

ABSTRACT: This article discusses the "bidirectional" relationship between inflammatory bowel disease (IBD) and physical activity. Intestinal symptoms and extraintestinal manifestations of IBD negatively impact a patient's ability to participate in sports. IBD also impacts athletic performance via its effects on muscle mass, muscle function, bone density, and fatigue. Surveys of IBD patients consistently show that IBD interferes with athletic participation. While IBD negatively affects physical activity, there is growing evidence that physical activity can be beneficial for IBD patients. Prospective studies have revealed that structured physical activities may positively influence inflammatory markers, disease activity, muscle strength, bone density, fatigue, stress, anxiety, and quality of life. This suggests that physical activity may be a simple and safe adjuvant therapy for IBD patients. Future studies assessing the optimal activity regimen are warranted. Finally, a cohort of professional athletes with IBD are described for the first time - football players in the National Football League.


Assuntos
Atletas , Desempenho Atlético/fisiologia , Exercício Físico/fisiologia , Doenças Inflamatórias Intestinais/fisiopatologia , Esportes/fisiologia , Ansiedade/terapia , Densidade Óssea/fisiologia , Eritema Nodoso/etiologia , Fadiga/fisiopatologia , Futebol Americano/fisiologia , Futebol Americano/estatística & dados numéricos , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/prevenção & controle , Artropatias/classificação , Artropatias/etiologia , Músculo Esquelético/fisiologia , Desempenho Físico Funcional , Pioderma Gangrenoso/etiologia , Qualidade de Vida , Esclerite/etiologia , Dermatopatias/etiologia , Estresse Fisiológico/fisiologia , Uveíte/etiologia
4.
Nihon Shokakibyo Gakkai Zasshi ; 118(7): 671-678, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34248080

RESUMO

A woman in her 40s, previously diagnosed with ulcerative colitis (UC), presented with anterior chest pain. A CT scan of her chest and skin examination showed no abnormal findings. She was initially managed with antibacterial agents, but her chest pain worsened, she developed a fever, and there was an overall deterioration of her general condition. A repeat CT scan found abscesses on the anterior surface of her sternum and gluteal region, and colonoscopy found worsening UC lesions. Her multiple subcutaneous abscesses were aseptic, and she was diagnosed with pyoderma gangrenosum (PG), an extraintestinal manifestation of UC. Steroid treatment was initiated and her overall condition as well as her subcutaneous abscesses improved rapidly. There are only a few case reports of PG without skin manifestation but only subcutaneous aseptic abscesses. However, subcutaneous abscesses may progress to PG with skin ulcers if initial treatment is delayed. Even with non-specific clinical features, prompt diagnosis of relapsed UC with potential extraintestinal manifestations must be considered. This is a rare case and aims to highlight the importance of early diagnosis and treatment of PG, which is an extraintestinal manifestation of relapsed UC.


Assuntos
Colite Ulcerativa , Pioderma Gangrenoso , Abscesso/diagnóstico por imagem , Abscesso/etiologia , Antibacterianos/uso terapêutico , Colite Ulcerativa/complicações , Colite Ulcerativa/tratamento farmacológico , Feminino , Humanos , Pioderma Gangrenoso/diagnóstico , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/etiologia
5.
BMJ Case Rep ; 14(5)2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33962915

RESUMO

Peristomal pyoderma gangrenosum (PPG) is a rare clinical entity, which can masquerade as the more common and lethal necrotising fasciitis. The authors present a case of PPG in a 65-year-old woman who underwent robotic abdominoperineal resection for low rectal carcinoma and returned 8 days postoperation for peristomal skin ulcerations and pain, accompanied by leucocytosis; thus, she was treated as per necrotising fasciitis and underwent surgical debridement. Thereafter, her wound continued to worsen despite conventional wound care with vacuum-assisted closure and demonstrated signs of pathergy. The case was referred to dermatology where a diagnosis of PPG was made. This case report presents a cautionary tale for fellow clinicians, highlights the diagnostic challenge, and presents an updated literature review on diagnosis and management of this unique condition.


Assuntos
Fasciite Necrosante , Pioderma Gangrenoso , Úlcera Cutânea , Estomas Cirúrgicos , Idoso , Diagnóstico Diferencial , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/etiologia , Fasciite Necrosante/terapia , Feminino , Humanos , Pioderma Gangrenoso/diagnóstico , Pioderma Gangrenoso/etiologia , Pioderma Gangrenoso/terapia , Estomas Cirúrgicos/efeitos adversos
7.
Ugeskr Laeger ; 183(11)2021 03 15.
Artigo em Dinamarquês | MEDLINE | ID: mdl-33734075

RESUMO

This case report describes a patient with colonic Crohn's disease and perianal disease. The patient experienced extensive and severe pyoderma gangrenosum after colectomy. Steroids and anti-inflammatory medication had no effect on pyoderma or the persistent perianal and rectal disease. All pyoderma lesions eventually healed after proctectomy and excision of perianal fistulae. The relevance and effect of surgically induced remission on medically resistant inflammatory bowel disease-associated pyoderma gangrenosum is highlighted.


Assuntos
Doença de Crohn , Doenças Inflamatórias Intestinais , Pioderma Gangrenoso , Colectomia , Doença de Crohn/tratamento farmacológico , Doença de Crohn/cirurgia , Humanos , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/etiologia , Cicatrização
8.
Rev. Hosp. Ital. B. Aires (2004) ; 41(1): 26-30, mar. 2021. ilus
Artigo em Espanhol | LILACS | ID: biblio-1178336

RESUMO

El pioderma gangrenoso ampollar es una variedad infrecuente de pioderma gangrenoso, que se asocia en el 50-70% de los casos con trastornos oncohematológicos. Se comunica el caso de una paciente de 59 años, que consultó por fiebre y ampollas purpúricas de rápida progresión, con compromiso cutáneo mucoso. Con sospecha de una enfermedad neutrofílica, ampollar, o infección por gérmenes oportunistas, se realizó biopsia de piel para estudio histopatológico, inmunofluorescencia directa y cultivo. Los cultivos y la inmunofluorescencia directa fueron negativos, y la anatomía patológica reveló un denso infiltrado inflamatorio con predominio neutrofílico en dermis. Ante el diagnóstico de pioderma gangrenoso ampollar, se realizó una punción-aspiración de médula ósea cuyo resultado fue compatible con leucemia mieloide aguda. Se instauró tratamiento con corticosteroides sistémicos, a pesar de lo cual la paciente evolucionó desfavorablemente y falleció a los 15 días de su ingreso hospitalario. Este caso ilustra la asociación de esta enfermedad cutánea con trastornos oncohematológicos y el mal pronóstico que esto implica a corto plazo. (AU)


Bullous pyoderma gangrenosum is an infrequent type of pyoderma gangrenosum, associated with onco hematological diseases in 50-70% of cases. We present the case of a 59-year-old patient with fever and mucocutaneous hemorrhagic bullous of rapid progression. A biopsy for histopathology, direct immunofluorescence (DIF) and skin culture was made, considering the possibility of neutrophilic dermatoses, bullous dermatosis or an opportunistic infection. The results of both the culture and the DIF were negative. The histopathological examination of the specimen revealed a dense dermal polymorphic infiltrate composed primarily of neutrophils. Considering bullous pyoderma gangrenosum as a potential diagnosis, a bone-marrow biopsy was performed. This study revealed an acute myeloid leukemia. Although systemic corticosteroid therapy was begun, the patient presented an unfavorable evolution that led to her death 15 days after her admission at the hospital. This case shows the association between bullous pyoderma gangrenosum and onco hematological diseases. In addition, it highlights the poor prognosis related to these diseases in the short term. (AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Leucemia Mieloide Aguda/patologia , Pioderma Gangrenoso/diagnóstico , Síndromes Paraneoplásicas/patologia , Respiração Artificial , Azacitidina/uso terapêutico , Síndromes Mielodisplásicas/patologia , Aciclovir/administração & dosagem , Metilprednisolona/administração & dosagem , Vancomicina/administração & dosagem , Cardiotônicos/uso terapêutico , Ceftazidima/administração & dosagem , Anfotericina B/administração & dosagem , Imipenem/administração & dosagem , Síndrome de Sweet/etiologia , Pioderma Gangrenoso/etiologia , Pioderma Gangrenoso/patologia , Pioderma Gangrenoso/tratamento farmacológico , Corticosteroides/uso terapêutico , Meropeném/administração & dosagem
10.
BMJ Case Rep ; 14(2)2021 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-33619133

RESUMO

A 35-year-old woman was referred urgently to the dermatology department because of significant wound breakdown 3 weeks following an emergency caesarean section. Examination revealed a full thickness, undermined ulcer spanning the width of the patient's caesarean scar, exposing the patient's uterus. Clinical appearances were consistent with pyoderma gangrenosum. The patient has a history of complicated pyoderma gangrenosum, having undergone skin grafts 14 years prior, for ulcers on her lower legs. That episode was the subject of a case report, published in the BMJ, in 2007. On this occasion, the patient was treated with oral corticosteroids, and ciclosporin based on its efficacy during her previous episode, which in conjunction with negative pressure wound therapy, resulted in complete re-epithelialisation of her ulcer within 6 months.


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Pioderma Gangrenoso , Corticosteroides , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Gravidez , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/etiologia , Transplante de Pele
11.
J Dermatol ; 48(4): 431-438, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33608949

RESUMO

Inflammatory bowel disease (IBD) presents with various extraintestinal manifestations. As part of them, various skin diseases are suggested to be related to IBD. We aimed to identify the epidemiology and risk of developing skin manifestations in patients with IBD. We used Korean insurance claims data and selected patients with IBD and age/sex-matched non-IBD subjects between 2013 and 2017 using the diagnosis code and prescription records of IBD-specific medications. The prevalence and risk of concurrent skin diseases were estimated. We identified 64 837 patients with IBD. Reactive skin eruptions including pyoderma gangrenosum and erythema nodosum were associated with IBD with highest odds ratios among three categories of reactive, inflammatory, and autoimmune skin diseases. Inflammatory skin diseases including rosacea, psoriasis, atopic dermatitis, hidradenitis suppurativa, and acne conglobata were significantly associated with IBD, but the association was less marked compared to reactive skin eruptions. The patients with IBD also had a higher risk of autoimmune skin diseases including vitiligo and alopecia areata than non-IBD subjects. We determined that IBD was related to various skin diseases including reactive, inflammatory, and autoimmune skin diseases. Considering these relationships can allow better management of patients with IBD and comorbid skin diseases.


Assuntos
Colite Ulcerativa , Eritema Nodoso , Doenças Inflamatórias Intestinais , Pioderma Gangrenoso , Estudos Transversais , Eritema Nodoso/epidemiologia , Eritema Nodoso/etiologia , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/epidemiologia , Pioderma Gangrenoso/epidemiologia , Pioderma Gangrenoso/etiologia , República da Coreia/epidemiologia
12.
Aesthet Surg J ; 41(7): NP709-NP716, 2021 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-33471065

RESUMO

Pyoderma gangrenosum (PG) is a rare, inflammatory dermatologic condition characterized by painful cutaneous ulcerations. Herein, we describe the third documented case of PG arising in an elective plastic surgery patient who had undergone an otherwise uncomplicated facelift. We describe the course of her diagnosis and management of PG, which involved her face and neck and then progressed to her lower extremities. Although the etiology remains unknown, PG often arises in a host with another autoimmune disease. In the case described, the patient was diagnosed with an immunoglobulin A gammopathy shortly after she developed PG. Following the case report, the pathogenesis, diagnosis, and treatment strategy of PG is briefly reviewed. Level of Evidence: 5.


Assuntos
Pioderma Gangrenoso , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Face/cirurgia , Feminino , Humanos , Pioderma Gangrenoso/diagnóstico , Pioderma Gangrenoso/etiologia , Pioderma Gangrenoso/terapia , Doenças Raras
15.
Pediatrics ; 146(5)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33115794

RESUMO

An 11-year-old girl with a congenitally malformed left hand, sickle cell trait, asthma, and history of appendicitis was transferred from Zambia for evaluation and treatment of widespread suppurative and ulcerative skin lesions that typically appeared after trauma to her skin. The ulcers first presented 3 years earlier but had markedly worsened in the 9 months before transfer, spreading circumferentially on her extremities and abdomen at the site of an appendectomy. They were painful and did not resolve with multiple courses of intravenous antibiotics and close management by a pediatric infectious disease specialist working for a nongovernmental organization (NGO) in her home country. Per NGO records, she had previously been  average weight-for-age. On presentation after international transfer, she was severely malnourished, with lesions covering âˆ¼35% of her body. In initial workup, leukocytosis of 21 × 103 cells per µL (79% neutrophils), hemoglobin of 6.1 g/dL, and mean corpuscular volume of 66 fL were found. Iron studies revealed an iron level of 18 µg/dL, ferritin level of 55 ng/mL, total iron binding capacity of 222 µg/dL, and transferrin saturation of 8%. Inflammatory markers were elevated, C-reactive protein was 20.1 mg/dL, and the erythrocyte sedimentation rate was 131 mm/h. A chest computed tomography scan revealed bilateral pulmonary nodules, the largest in her left upper lobe measuring 2.4 × 2.0 × 1.9 cm. Our panel of experts reviews the evaluation and treatment of this patient with extensive suppurative and ulcerative skin lesions and the factors considered in offering charity care to international patients.


Assuntos
Desnutrição/complicações , Pioderma Gangrenoso/diagnóstico , Pioderma Gangrenoso/etiologia , Úlcera Cutânea/etiologia , Criança , Doença Crônica , Feminino , Humanos , Zâmbia
17.
Aesthetic Plast Surg ; 44(6): 2032-2040, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32767036

RESUMO

BACKGROUND: Pyoderma gangrenosum (PG) is a rare inflammatory cutaneous disorder. Although PG is a diagnosis of exclusion, prompt recognition is essential to attain the desired outcomes. From an aesthetic standpoint, this is especially critical with breast involvement and other body segments. We present a consecutive case series of four patients who developed PG following breast surgery and responded to early intervention. METHODS: A chart review identified four patients who were identified as having developed PG after either aesthetic or reconstructive breast surgery. Their histories, associated risk factors, diagnosis, course of treatment, and results were documented. The PubMed database was then searched to find the literature for comparison. RESULTS: The average time from surgery to the onset of symptoms was 11 days, and the average time from the onset of symptoms to the correct diagnosis of PG was 41 days. The average length of steroid therapy was 25 days. The average time from the initiation of steroids to complete wound closure was 51 days. The average time from the onset of symptoms to complete wound closure bilaterally was 87 days. All wounds healed with conservative management. CONCLUSION: Postsurgical PG is a rare but recognized cause of postoperative wound breakdown in patients who have undergone plastic surgery procedures to the breast. Early recognition and treatment can facilitate prompt reversal of the inflammatory process leading to complete wound healing and limitation of the morbidity that can be associated with the disease. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Neoplasias da Mama , Mamoplastia , Pioderma Gangrenoso , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Mamoplastia/efeitos adversos , Mastectomia/efeitos adversos , Pioderma Gangrenoso/diagnóstico , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/etiologia , Cicatrização
18.
Dermatol Ther ; 33(6): e14121, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32743854

RESUMO

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by rapidly progressing necrolytic ulceration of the skin. Proper treatment is crucial since it can result in devastating consequences. First-line treatments include systemic corticosteroids or cyclosporine. However, no standardized treatment regimens for refractory cases exist and treatment outcomes are affected by underlying conditions. PG after cesarean section, which is believed to occur in association with underlying pregnancy- and parturition-related immune changes, is extremely rare, and all reported cases in the literature have been successfully treated with systemic or topical corticosteroids. We report a case of a 32-year-old patient with severe PG occurring on her cesarean scar 3 days after the cesarean delivery. Treatment with systemic corticosteroids and first-line immunomodulatory agents resulted in insufficient response and serious complications. Intravenous immunoglobulin (IVIG) was then initiated, and a rapid clinical response was seen. Corticosteroid dose was gradually decreased and ceased. IVIG infusion was continued for 3 months until complete recovery. Reactivation was not observed in a 1-year follow-up period. Due to its cost, IVIG infusion is less suitable as a first-line agent. However, IVIG may be an important therapeutic option in resistant postpartum PG, in which first-line agents have failed or led to complications.


Assuntos
Imunoglobulinas Intravenosas , Pioderma Gangrenoso , Corticosteroides , Adulto , Cesárea/efeitos adversos , Ciclosporina , Feminino , Humanos , Gravidez , Pioderma Gangrenoso/diagnóstico , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/etiologia
19.
JBJS Case Connect ; 10(2): e0562, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649133

RESUMO

CASE: We present a case of a 60-year-old polytraumatized man who developed postoperative pyoderma gangrenosum (PG) after his initial stabilization procedures, mimicking a postoperative infection. This caused a delay in diagnosis, leading to progression of his wounds and a delay in initiation of the appropriate treatment. Once his PG was appropriately treated, his clinical status and wounds improved. He underwent successful wound coverage by plastic surgery and has been recovering from his injuries. CONCLUSION: Prompt identification and initiation of treatment for postoperative PG is critical to avoid exacerbation of wounds and subsequent morbidity to the patient.


Assuntos
Fraturas Expostas/complicações , Traumatismos da Perna/complicações , Traumatismo Múltiplo/complicações , Complicações Pós-Operatórias/etiologia , Pioderma Gangrenoso/etiologia , Acidentes de Trânsito , Fraturas Expostas/diagnóstico por imagem , Fraturas Expostas/cirurgia , Humanos , Traumatismos da Perna/diagnóstico por imagem , Traumatismos da Perna/cirurgia , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/cirurgia , Complicações Pós-Operatórias/cirurgia , Pioderma Gangrenoso/cirurgia , Radiografia , Retalhos Cirúrgicos
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