Pyoderma Gangrenosum-Like Lesion in an Older Adult

Area of Science:

• Dermatology
• Internal Medicine

Background:

• Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis.
• It typically affects younger to middle-aged adults, presenting as ulcerative lesions with violaceous borders.
• Diagnosis and management can be challenging, especially in elderly patients with comorbidities.

Purpose of the Study:

• To present a case of idiopathic PG-like ulcer in an elderly nursing home patient.
• To emphasize the diagnostic challenges and treatment considerations for PG in older adults.
• To highlight the efficacy of low-dose corticosteroids in treating PG.

Main Methods:

• A case report of a 79-year-old female nursing home resident with a lower extremity ulcer.
• Initial treatment for presumed cellulitis with antibiotics and topical wound care proved ineffective.
• Treatment with a short course of low-dose prednisone (15 mg/d) was initiated.

Main Results:

• The patient's PG-like ulcer showed rapid healing after one week of prednisone therapy.
• Antibiotic treatment and topical wound care failed to resolve the lesion.
• The case underscores the potential for misdiagnosis in elderly patients with atypical ulcers.

Conclusions:

• Pyoderma gangrenosum should be considered in older patients presenting with distinctive inflammatory ulcers unresponsive to antibiotics.
• Early recognition and treatment with corticosteroids can lead to rapid healing.
• This case emphasizes the importance of considering PG in the differential diagnosis of non-healing ulcers in the elderly, even with comorbidities.