Artina Pajaziti* and Gramoz Bunjaku
Background: Pyoderma Gangrenosum (PG) is a rare, neutrophilic, non-infectious, inflammatory dermatosis, clinically characterized by progressive necrotic and purulent tissue ulceration. In up to half of the cases the etiology remains idiopathic, whereas the other half of patients present with an underlying systemic disorder (inflammatory bowel disease, rheumatoid arthritis or lymphoproliferative disorder). The lower legs are most frequently affected although PG can present at any body site. Being a diagnosis of exclusion, there is often a failure of early detection. Innacurate diagnosis and treatment often cause the clinical overview to change, thus leading to progression.
Case presentation: A 49-year old, otherwise healthy, male patient presented with painful necrotic ulcers in lower extremities. He had been treated as pyodermia for two years. The edge-ulcer biopsy resulted in neutrophilic infliltrates. The patients condition showed great remission under systemic corticosteroids and immunosupressants.
Conclusion: This case highlights the challenges for early detection of pyoderma gangrenosum, considering the wide spectrum of differential diagnosis. Clinial determination of the morphological characteristics of the lesions, non-responding antibiotic treatment and improvement after corticosteroids should serve as guidance to early diagnosis and management of the disease.
