Pyoderma gangrenosum

From Libre Pathology
Jump to navigation Jump to search

Pyoderma gangrenosum, abbreviated PG, is a benign inflammatory skin disorder associated with inflammatory bowel disease.

General

Clinical

  • Pathergy = minor trauma (to the skin) results in a non-healing lesion.[2]

Gross

  • Skin ulceration - classically on the legs.[1]

Microscopic

Features:[1]

  • Early: lymphocytes cells only in the dermis - often perivascular & vascular.
    • +/-Fibrinoid necrosis of vessels at edge of lesion.
  • Late: abscess formation (neutrophils).

DDx:

Image

Sign out

A. Skin, Left Leg from Central Wound, Punch Biopsy:
- Necrotic debris with underlying granulation tissue and benign connective tissue
  with superficial vasculitis, see comment.
- NEGATIVE for skin surface.

B. Skin, Left Leg from Wound and Normal Skin Junction, Punch Biopsy:
- Skin with ulceration, necrotic debris, and superficial vasculitis, see comment.
- Fat necrosis and severe atherosclerosis.

Comment:
The findings are in keeping with pyoderma gangrenosum; however, atherosclerotic disease 
and vasculitis should be considered clinically.  

The vasculitis is seen superficially and is likely secondary to the ulceration.

Alternate

Skin, Left Lower Leg, Punch Biopsy:
- Skin with ulceration, necrotic debris, superficial vasculitis, 
  subepidermal fibrosis and maturing granulation tissue, see comment.
- NEGATIVE for evidence of malignancy.

Comment: 
The findings are in keeping with pyoderma gangrenosum; however, vasculitis and 
atherosclerosis should be considered clinically. 

The vasculitis is seen superficially and is favoured to be secondary to 
the ulceration.

See also

References

  1. 1.0 1.1 1.2 Brooklyn, T.; Dunnill, G.; Probert, C. (Jul 2006). "Diagnosis and treatment of pyoderma gangrenosum.". BMJ 333 (7560): 181-4. doi:10.1136/bmj.333.7560.181. PMC 1513476. PMID 16858047. //www.ncbi.nlm.nih.gov/pmc/articles/PMC1513476/.
  2. Wong, WW.; Machado, GR.; Hill, ME.. "Pyoderma gangrenosum: the great pretender and a challenging diagnosis.". J Cutan Med Surg 15 (6): 322-8. PMID 22202507.