Atypical Visceral Involvement of Pyoderma Gangrenosum

Pyoderma gangrenosum is a noninfectious reactive inflammatory dermatosis included in the spectrum of neutrophilic dermatoses. Extracutaneous manifestations of pyoderma gangrenosum are rare, but when visceral lesions occur, they are typically detected through radiologic tests, can be cavitated or noncavitated, and progress rapidly. Because of the difficult etiologic diagnosis of these lesions, the use of nonproductive and potentially harmful invasive procedures and treatments is common.

A 58-year-old female with a history of ulcerative colitis presented to the emergency department with a history of pain in the right sternoclavicular joint radiating to the shoulder. Cervicothoracic computed tomography (CT) suggested right sternoclavicular arthritis. During hospitalization, the patient experienced a flare of ulcerative colitis and developed cutaneous lesions. The patient worsened clinically with increased abdominal pain in the left hemiabdomen and elevated acute phase reactants. Thoracoabdominal CT revealed a hypodense lesion on the anterior aspect of the spleen that was deemed a splenic abscess, and ultrasound-guided percutaneous drainage was placed. Cultures were negative. Subsequently, 2 cutaneous lesions appeared on the patient's right arm, suggestive of abscesses related to attempts to place a midline catheter. All cultures were negative. Given the negative microbiologic cultures and the appearance of cutaneous lesions, pyoderma gangrenosum with visceral involvement was diagnosed and the patient was successfully treated with infliximab.

While visceral involvement of pyoderma gangrenosum is uncommon, correct diagnosis is crucial to avoid unnecessary treatments and interventions.