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[Ulcerative colitis diagnosed with facial pyoderma gangrenosum: a case report]
Yudai Ogata1, Atsuko Soeda1, Isao Saura1
1Division of Gastroenterology, Tsukuba Memorial Hospital.
Summary
Facial pyoderma gangrenosum (PG), a rare inflammatory skin condition, was successfully treated in a teenager with ulcerative colitis (UC). Effective treatment of IBD is crucial for managing severe skin manifestations like PG.
Area of Science:
- Dermatology
- Gastroenterology
- Immunology
Background:
- Pyoderma gangrenosum (PG) is a sterile inflammatory skin disorder often linked to immune-related conditions like inflammatory bowel disease (IBD).
- Facial PG is rare, with typical presentations on the trunk and lower limbs.
- Early misdiagnosis of facial PG as infectious acne can delay appropriate treatment.
Purpose of the Study:
- To report a rare case of facial pyoderma gangrenosum in a teenager.
- To highlight the association between PG and ulcerative colitis (UC) even with atypical IBD symptoms.
- To emphasize the importance of integrated treatment for both skin and gastrointestinal conditions.
Main Methods:
- Clinical presentation of fever, facial pustules, ulcers, and necrosis.
- Dermal and subcutaneous biopsy revealing neutrophil infiltration consistent with PG.
- Diagnostic workup including blood tests (anemia, fecal occult blood) and sigmoidoscopy confirming ulcerative colitis (UC).
Main Results:
- The patient presented with severe facial lesions initially misdiagnosed as complicated acne.
- Biopsy confirmed pyoderma gangrenosum, and further investigations revealed underlying ulcerative colitis.
- Combined treatment with prednisolone, skin grafts, and golimumab led to remission of both PG and UC.
Conclusions:
- Facial pyoderma gangrenosum is an uncommon but serious manifestation that can be associated with inflammatory bowel disease.
- Prompt diagnosis and integrated management of both PG and IBD are essential for successful patient outcomes.
- Effective treatment of IBD is critical for managing complex dermatological conditions like PG, facilitating procedures like skin grafting.
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