Multiple Pyoderma Gangrenosum Overlying AV Fistula Treated With Colchicine: A Case Report

Area of Science:

• Dermatology
• Nephrology
• Vascular Surgery

Background:

• Pyoderma gangrenosum (PG) is a rare, painful neutrophilic dermatosis.
• Pathergy, PG triggered by trauma, is a known phenomenon.
• Arteriovenous fistulas (AVFs) are crucial for hemodialysis access.

Purpose of the Study:

• To report the first case of PG arising from pathergy due to needle insertion over an AVF.
• To inform nephrologists about this rare presentation of PG.
• To discuss management strategies for PG in hemodialysis patients.

Main Methods:

• A 69-year-old female patient with chronic renal insufficiency on hemodialysis presented with ulcers at AVF needle sites.
• Clinical diagnosis of PG was made, excluding secondary causes.
• Treatment involved temporary suspension of AVF dialysis, systemic prednisone, topical corticosteroids, and initiation of colchicine for prevention.

Main Results:

• Patient's lesions improved with prednisone and topical corticosteroids.
• Colchicine and topical corticosteroids led to continued improvement after prednisone taper.
• Dialysis via AVF was safely resumed after a negative pathergy test, with no recurrence.

Conclusions:

• This is the first reported case of PG secondary to pathergy from AVF needle insertion.
• Colchicine appears to be a safe and effective option for long-term PG management in hemodialysis patients.
• Awareness of this PG presentation is crucial for nephrologists managing hemodialysis access.