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A Case of Pustular Pyoderma Gangrenosum Misdiagnosed as Acute Febrile Neutrophilic Dermatosis in a Pediatric Patient
Xiaoli Yang1, Yongzhuo Wu1, Fuqiong Jiang1
1Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650101, People's Republic of China.
Insights
Pyoderma gangrenosum (PG) is a rare pediatric skin ulcer condition. Early detection and treatment with medications like adalimumab are crucial for managing this challenging disease, especially when associated with inflammatory bowel disease.
Area of Science:
- Pediatric Dermatology
- Rheumatology
- Gastroenterology
Background:
- Pyoderma gangrenosum (PG) is a rare ulcerative skin condition in children.
- Diagnosis and treatment are challenging and often require multidisciplinary collaboration.
- Increased awareness among non-dermatologists, especially pediatricians, aids early detection.
Observation:
- An 11-year-old patient initially diagnosed with acute febrile neutrophilic dermatosis.
- Confirmed diagnosis of pustular PG through histopathology and other examinations.
- Condition improved with a combination of glucocorticoids and adalimumab.
Findings:
- Pediatric pustular PG is rare, often presenting with persistent fever and pustules post-trauma.
- Adalimumab shows promise as a treatment for pediatric IBD-associated pustular PG.
- Histopathological examination is key for confirming pustular PG.
Implications:
- Highlights the importance of considering pediatric pustular PG in children with unexplained fever and pustules.
- Suggests adalimumab as a potential therapeutic option for this specific patient group.
- Emphasizes the need for prompt diagnosis and tailored treatment strategies.
Background:
Pyoderma gangrenosum (PG) is a rare cause of skin ulcers in children, posing challenges in diagnosis and treatment. As the disease is often associated with conditions such as inflammatory bowel disease (IBD), rheumatoid arthritis, haematological disorders and other diseases, diagnosis and treatment often require cooperation with other medical departments. Accordingly, dissemination of information about the disease to doctors in departments other than dermatologists, especially paediatricians, can help in its early detection.
Case Presentation:
The 11-year-old pediatric patient in the case initially diagnosed with acute febrile neutrophilic dermatosis was eventually confirmed as pustular PG through histopathological examinations of skin and other relevant examinations. The medical condition is lessened after treatment with a combination of glucocorticoids and adalimumab.
Conclusion:
PG is relatively rare in clinical settings, particularly among pediatric patients exhibiting persistent high fever and signs of pustular pyoderma gangrenosum. This case underscores the importance of considering the potential diagnosis of pediatric pustular PG when confronted with a child presenting persistent high fever and pustules after trauma. Additionally, the proactive initiation of adalimumab emerges as a promising treatment option for pediatric IBD -associated pustular PG.
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