Pyoderma gangrenosum on the nose

Area of Science:

• Dermatology
• Otolaryngology
• Gastroenterology

Background:

• Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis often associated with systemic diseases.
• While typically affecting the extremities and trunk, nasal PG is exceptionally uncommon.

Observation:

• A 33-year-old woman presented with fever, nasal obstruction, and painful nasal bridge swelling.
• Initial symptoms included bilateral septal abscesses and subcutaneous nasal bridge abscesses, unresponsive to antibiotics and drainage.
• Concurrent diagnosis of ulcerative colitis was established.

Findings:

• Nasal pyoderma gangrenosum was diagnosed by exclusion and confirmed by rapid improvement with systemic corticosteroids.
• The condition led to significant nasal complications, including saddle nose deformity.
• Literature review indicates PG can cause nasal ulcerations, septal abscesses, sinusitis, septal perforation, and skin defects.

Implications:

• Nasal pyoderma gangrenosum should be considered in the differential diagnosis for refractory nasal ulcerations, abscesses, and sinusitis.
• Prompt recognition and appropriate treatment, including corticosteroids, are vital to prevent severe nasal sequelae.
• This case highlights the importance of a multidisciplinary approach in managing rare dermatological conditions with systemic associations.