Pyoderma Gangrenosum Masquerading as Chronic Infective Ulcers: Two Case Reports Across Age Extremes.

Area of Science:

• Dermatology
• Immunodermatology

Background:

• Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by ulcerative lesions.
• Diagnostic challenges arise from clinical heterogeneity and lack of specific markers, leading to misdiagnosis and delayed treatment.
• Early misdiagnosis of PG as infectious ulcers can increase patient morbidity.

Purpose of the Study:

• To report two cases of pyoderma gangrenosum (PG) in atypical age groups (elderly and child).
• To highlight diagnostic challenges and the utility of the Delphi Consensus Criteria in managing PG.
• To emphasize the importance of early immunosuppressive therapy for PG.

Main Methods:

• Case report of a 90-year-old male and a 10-year-old boy with pyoderma gangrenosum.
• Clinical diagnosis based on the Delphi Consensus Criteria (2018), fulfilling seven of eight minor criteria.
• Treatment with systemic corticosteroids and monitoring of clinical response.

Main Results:

• Both patients presented with non-healing ulcers, rapid progression, pathergy, and lack of response to antimicrobials.
• Clinical diagnosis of PG was established despite absent histopathological confirmation.
• Systemic corticosteroids resulted in rapid and sustained improvement in both cases.

Conclusions:

• Pyoderma gangrenosum should be considered in non-healing ulcers unresponsive to standard treatments, especially with features like pathergy.
• The Delphi Consensus Criteria provide a valuable framework for clinical diagnosis of PG.
• Prompt initiation of immunosuppressive therapy, such as corticosteroids, is essential for favorable outcomes in PG.