Malignant pyoderma. Report of a case associated with a disorder of the immune system

A 41-year-old man developed multiple suppurative ulcers and subcutaneous inflammatory nodules and abscesses on the face, the trunk and the extremities. Repeated bacterial and fungus cultures gave nonspecific and inconstant results. Light-microscopic studies showed diffuse inflammatory reaction in the dermis with abscess formation and tissue destruction. There was no evidence of blood vessel inflammatory changes. The course of the disease was characterized by marked chronicity and partial response to systemic steroid and antibiotic therapy. Treatment with clofazimine resulted in a marked improvement of the lesions. Laboratory test results suggest that a deficiency of cell-mediated immunity, associated with increased concentrations of immunoglobulins, may have been the pathogenic event in this case.