Peritonsillar Involvement in Pyoderma Gangrenosum associated with Ulcerative Colitis.

Area of Science:

• Otolaryngology
• Gastroenterology
• Dermatology

Background:

• Peritonsillar abscess is a frequent deep throat infection requiring prompt management.
• Ulcerative colitis (UC) can present with extraintestinal manifestations, including skin lesions.
• Pyoderma gangrenosum (PG) is a rare, ulcerative neutrophilic dermatosis often associated with systemic diseases like UC.

Purpose of the Study:

• To report a unique case of peritonsillar abscess as an unusual manifestation of pyoderma gangrenosum associated with ulcerative colitis.
• To describe the successful treatment of this complex condition with infliximab.

Main Methods:

• A 45-year-old female patient with a history of ulcerative colitis (UC) presented with severe sore throat and skin ulcers.
• Computed tomography (CT) of the neck confirmed a peritonsillar abscess.
• Diagnosis was established based on clinical presentation, CT findings, skin biopsy (suggesting PG), and negative abscess cultures, leading to a final diagnosis of peritonsillar involvement of steroid-refractory PG-associated UC.

Main Results:

• The patient's peritonsillar abscess and skin ulcers were initially refractory to steroid treatment.
• Treatment with infliximab resulted in a complete clinical response, resolving both the deep throat infection and the skin lesions.
• Abscess cultures were negative, and skin biopsy supported pyoderma gangrenosum.

Conclusions:

• Peritonsillar abscess can be an atypical manifestation of pyoderma gangrenosum in patients with ulcerative colitis.
• Infliximab demonstrates efficacy in managing steroid-refractory peritonsillar involvement of pyoderma gangrenosum-associated UC.
• This case underscores the importance of considering systemic inflammatory conditions in deep neck infections.