Pyoderma chronica vegetans treated with mesh skin grafting

Area of Science:

• Dermatology
• Immunology

Background:

• Pyoderma chronica vegetans is a rare disorder characterized by verrucous plaques and pustules, potentially linked to immune dysfunction.
• The exact etiology remains unknown, but immune system dysfunction or immunosuppression is suspected.

Observation:

• A 72-year-old male presented with extensive pyoderma chronica vegetans on the buttocks, including fistulas, scarring, and verrucous plaques.
• Laboratory findings revealed elevated erythrocyte sedimentation rate, anemia, leukocytosis with a left shift, and polyclonal hyperglobulinemia.
• Histopathology showed epidermal hyperplasia, sinus and abscess formation, fibrosis, and a mixed inflammatory infiltrate.

Findings:

• Tissue cultures identified Streptococcus species and Escherichia coli.
• T-cell functional tests indicated decreased responsiveness to mitogens, while monocyte and granulocyte phagocytic capabilities were normal.
• Conservative treatments were ineffective, necessitating surgical intervention.

Implications:

• Complete surgical excision and subsequent skin grafting successfully treated the extensive lesions.
• The patient achieved a good postoperative outcome with no recurrence of the pyodermatic process.
• This case highlights surgical management as a viable option for recalcitrant pyoderma chronica vegetans.