All that is red is not cellulitis. Pyoderma gangrenosum.

Area of Science:

• Dermatology
• Gastroenterology
• Internal Medicine

Background:

• Pyoderma gangrenosum is a rare, destructive neutrophilic dermatosis.
• It often presents as a painful ulcer, frequently on the lower extremities.
• Diagnosis can be challenging, and it is frequently misdiagnosed initially.

Observation:

• A 60-year-old female presented with a progressive, non-healing shin ulcer after minor trauma.
• The ulcer had surrounding erythema and did not respond to antibiotic treatment for presumed cellulitis.
• A skin biopsy was performed due to lack of improvement.

Findings:

• Skin biopsy results were suggestive of pyoderma gangrenosum.
• Further investigation with a colonic biopsy revealed an underlying diagnosis of ulcerative colitis.
• This case highlights a potential association between pyoderma gangrenosum and inflammatory bowel disease.

Implications:

• Early recognition and biopsy are crucial for diagnosing pyoderma gangrenosum.
• Identifying underlying systemic conditions, such as ulcerative colitis, is essential for effective management.
• This case underscores the importance of a multidisciplinary approach in managing complex dermatological conditions with systemic links.