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Ophthalmic Plastic and Reconstructive...A 72-year-old woman with a history of chronic cocaine use presented 9 months after a dog bite with a large facial ulceration and absent sinonasal structures. Biopsies... (Review)
Review
A 72-year-old woman with a history of chronic cocaine use presented 9 months after a dog bite with a large facial ulceration and absent sinonasal structures. Biopsies were negative for infectious, vasculitic, or neoplastic pathologies. The patient was lost to follow up for 15 months and returned with a significantly larger lesion despite abstinence from cocaine. Additional inflammatory and infectious workup was negative. Intravenous steroids were administered with clinical improvement. Therefore, she was diagnosed with pyoderma gangrenosum and cocaine-induced midline destructive lesion due to cocaine/levamisole. Pyoderma gangrenosum is a rare dermatologic condition that uncommonly involves the eye and ocular adnexa. Diagnosis involves clinical examination, response to steroids, exclusion of infectious or autoimmune conditions, and identifying potential triggers including cocaine/levamisole. This report highlights a rare presentation of periorbital pyoderma gangrenosum causing cicatricial ectropion associated with concomitant cocaine-induced midline destructive lesion and reviews important aspects of clinical manifestations, diagnosis, and management of pyoderma gangrenosum and cocaine/levamisole autoimmune phenomenon.
Topics: Female; Animals; Dogs; Humans; Cocaine; Pyoderma Gangrenosum; Levamisole; Face; Skin Ulcer
PubMed: 36893063
DOI: 10.1097/IOP.0000000000002347 -
Journal of the Royal Society of Medicine May 1995Hidradenitis suppurativa, a chronic inflammatory condition of the apocrine gland follicles, may rarely be complicated by pyoderma gangrenosum (PG). We report such a...
Hidradenitis suppurativa, a chronic inflammatory condition of the apocrine gland follicles, may rarely be complicated by pyoderma gangrenosum (PG). We report such a case, in which the immunosuppressant cyclosporin A (CyA) was given to treat PG and a dramatic improvement occurred in the patient's intractable perineal HS.
Topics: Cyclosporine; Hidradenitis Suppurativa; Humans; Male; Middle Aged; Pyoderma Gangrenosum
PubMed: 7636825
DOI: No ID Found -
The Journal of Veterinary Medical... Feb 2021Currently, antimicrobial-resistant staphylococci, particularly methicillin-resistant Staphylococcus pseudintermedius (MRSP), are frequently isolated from canine...
Currently, antimicrobial-resistant staphylococci, particularly methicillin-resistant Staphylococcus pseudintermedius (MRSP), are frequently isolated from canine superficial pyoderma in Japan. However, little is known regarding the nasal prevalence of MRSP in pet dogs. Here, we determined the prevalence of antimicrobial-resistant staphylococci in nares and affected sites of pet dogs with superficial pyoderma. Of the 125 nares and 108 affected sites of pet dogs with superficial pyoderma, 107 (13 species) and 110 (eight species) staphylococci strains, respectively, were isolated. The isolation rate of S. pseudintermedius from pyoderma sites (82/110 strains, 74.5%) was significantly higher than that from nares (57/107 strains, 53.3%) (P<0.01). Notably, the prevalence of MRSP (18/57 strains, 31.6%) in nares was equivalent to that in pyoderma sites (28/82 strains, 34.1%). Furthermore, the phenotypes and genotypes of antimicrobial resistance in MRSP strains from nares were similar to those from pyoderma sites. Our findings revealed that the prevalence of antimicrobial-resistant staphylococci in the nares of pet dogs with superficial pyoderma is the same level as that in affected sites. Therefore, considerable attention should be paid to the antimicrobial resistance of commensal staphylococci in companion animals.
Topics: Animals; Anti-Infective Agents; Dog Diseases; Dogs; Drug Resistance, Bacterial; Japan; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Nose; Pets; Prevalence; Pyoderma; Staphylococcal Infections; Staphylococcus
PubMed: 33342967
DOI: 10.1292/jvms.20-0439 -
Wounds : a Compendium of Clinical... May 2018Pyoderma gangrenosum (PG) is a rare, inflammatory, noninfectious skin disorder that is idiopathic in nature; however, it may occur as a rare complication of breast...
INTRODUCTION
Pyoderma gangrenosum (PG) is a rare, inflammatory, noninfectious skin disorder that is idiopathic in nature; however, it may occur as a rare complication of breast surgery. The mainstay of treatment is medical immunosuppression.
CASE REPORT
This report describes the case of a 46-year-old woman who developed PG of both breasts following bilateral reduction mammoplasty and mastopexy. She was managed with a combination of medical immunotherapy and full-thickness skin grafts, which resulted in successful wound healing.
CONCLUSIONS
This patient's positive outcome illustrates the use of skin grafts in combination with medical immunotherapy in the setting of PG. This approach, which differs from the common method of treating solely with medical immunotherapy, may provide a quicker and more satisfying result for the patient.
Topics: Breast Diseases; Cyclosporine; Female; Free Tissue Flaps; Humans; Immunosuppressive Agents; Mammaplasty; Middle Aged; Prednisone; Pyoderma Gangrenosum; Plastic Surgery Procedures; Skin Transplantation; Surgical Wound Infection; Treatment Outcome; Wound Healing
PubMed: 29847306
DOI: No ID Found -
Actas Dermo-sifiliograficas Dec 2017
Review
Topics: Aged; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Myeloproliferative Disorders; Prednisone; Pyoderma Gangrenosum; Ultrasonography; Ultrasonography, Doppler, Color
PubMed: 28705518
DOI: 10.1016/j.ad.2017.02.025 -
Dermatology Online Journal Apr 2012Pyoderma gangrenosum (PG) is an uncommon neutrophilic dermatosis that can have a chronic course often leading to ulceration and extreme tenderness. Treatment is often...
Pyoderma gangrenosum (PG) is an uncommon neutrophilic dermatosis that can have a chronic course often leading to ulceration and extreme tenderness. Treatment is often directed toward reducing the inflammatory process to prevent progression of the ulcer and minimize pain. The mainstay of therapy is systemic corticosteroids. Other immunosuppressants have been utilized in cases of PG resistant to corticosteroids, including cyclosporine and tacrolimus. A patient with severe and recalcitrant PG was prescribed systemic corticosteroids and cyclosporine but continued to have progression of her disease warranting admission to the hospital. Her hospital course was complicated requiring hospitalization for one month. Although her health was deteriorating, her PG improved in the hospital setting with corticosteroids without concomitant cyclosporine. The patient admitted to non-compliance with her medication in the outpatient setting, attributing her behavior mainly to depression. Pyoderma gangrenosum can be recalcitrant to any form of therapy and medication non-adherence must be considered a potential cause.
Topics: Anti-Inflammatory Agents; Cyclosporine; Depression; Female; Hospitalization; Humans; Immunosuppressive Agents; Medication Adherence; Methylprednisolone; Middle Aged; Prednisone; Pyoderma Gangrenosum; Treatment Failure
PubMed: 22559023
DOI: No ID Found -
Anais Brasileiros de Dermatologia 2019Pyoderma gangrenosum is a neutrophilic dermatosis characterized by chronic ulcers due to an abnormal immune response. Despite the existence of diagnostic criteria, there...
Pyoderma gangrenosum is a neutrophilic dermatosis characterized by chronic ulcers due to an abnormal immune response. Despite the existence of diagnostic criteria, there is no gold standard for diagnosis or treatment. In Latin America, recognizing and treating pyoderma gangrenosum is even more challenging since skin and soft tissue bacterial and non-bacterial infections are common mimickers. Therefore, this review aims to characterize reported cases of pyoderma gangrenosum in this region in order to assist in the assessment and management of this condition. Brazil, Mexico, Argentina, and Chile are the countries in Latin America that have reported the largest cohort of patients with this disease. The most frequent clinical presentation is the ulcerative form and the most frequently associated conditions are inflammatory bowel diseases, inflammatory arthropaties, and hematologic malignancies. The most common treatment modalities include systemic corticosteroids and cyclosporine. Other reported treatments are methotrexate, dapsone, and cyclophosphamide. Finally, the use of biological therapy is still limited in this region.
Topics: Diagnosis, Differential; Humans; Latin America; Prevalence; Pyoderma Gangrenosum
PubMed: 31789268
DOI: 10.1016/j.abd.2019.06.001 -
Medicine Sep 2008Erythema nodosum and pyoderma gangrenosum are the most common cutaneous manifestations in inflammatory bowel diseases (IBD). We conducted the current study to assess the...
Erythema nodosum and pyoderma gangrenosum are the most common cutaneous manifestations in inflammatory bowel diseases (IBD). We conducted the current study to assess the cumulative prevalence of erythema nodosum and pyoderma gangrenosum in patients with IBD and to appraise their association with demographic, clinical, and prognostic factors related to IBD. Between 2000 and 2005, data for all patients with IBD at our gastroenterology department were prospectively and systematically collected using a standardized protocol. Among 2402 patients (1521 diagnosed with Crohn disease [63.3%] and 744 with ulcerative colitis [31.0%]), 140 (5.8%) had at least 1 skin manifestation. The most frequent dermatologic symptoms were erythema nodosum (4.0%) and pyoderma gangrenosum (0.75%). In multivariate analyses, erythema nodosum was significantly and independently associated with a diagnosis of Crohn disease (p < 0.001), female sex (p < 0.001), eye and joint involvement (p < 0.001), and pyoderma gangrenosum (p < 0.0001). Among patients with Crohn disease, erythema nodosum was associated with isolated colonic involvement (p = 0.0001). Pyoderma gangrenosum was significantly and independently associated with black African origin (p = 0.003), familial history of ulcerative colitis (p = 0.0005), uninterrupted pancolitis as the initial location of IBD (p = 0.03), permanent stoma (p = 0.002), eye involvement (p = 0.001), and erythema nodosum (p < 0.0001). It is noteworthy that the association between pyoderma gangrenosum and permanent stoma persisted after exclusion of patients with peristomal pyoderma gangrenosum (p = 0.07). In conclusion, neither erythema nodosum nor pyoderma gangrenosum was significantly associated with the severity criteria in IBD; however, their occurrence may reflect a peculiar phenotype among affected patients.
Topics: Adult; Cohort Studies; Erythema Nodosum; Female; Humans; Inflammatory Bowel Diseases; Male; Multivariate Analysis; Prevalence; Prospective Studies; Pyoderma Gangrenosum; Risk Factors
PubMed: 18794711
DOI: 10.1097/MD.0b013e318187cc9c -
Proceedings of the Royal Society of... May 1962
Topics: Connective Tissue Diseases; Humans; Medical Records; Organic Chemicals; Pemphigus; Pyoderma; Skin Diseases, Bacterial
PubMed: 13914347
DOI: No ID Found -
BMC Microbiology Apr 2019Concern exists that frequent use of topically-applied fusidic acid (FA) and chlorhexidine (CHX) for canine pyoderma is driving clinically relevant resistance, despite...
BACKGROUND
Concern exists that frequent use of topically-applied fusidic acid (FA) and chlorhexidine (CHX) for canine pyoderma is driving clinically relevant resistance, despite rare description of FA and CHX genetic resistance determinants in canine-derived staphylococci. This study aimed to determine minimum inhibitory concentrations (MICs) and investigate presence of putative resistance determinants for FA and CHX in canine-derived methicillin-resistant (MR) and -susceptible (MS) staphylococci. Plasmid-mediated resistance genes (fusB, fusC, fusD, qacA/B, smr; PCR) and MICs (agar dilution) of FA and CHX were investigated in 578 staphylococci (50 MR S. aureus [SA], 50 MSSA, 259 MR S. pseudintermedius [SP], 219 MSSP) from Finland, U.S.A., North (NUK) and South-East U.K. (SEUK) and Germany. In all isolates with FA MIC ≥64 mg/L (n = 27) fusA and fusE were amplified and sequenced.
RESULTS
FA resistance determinants (fusA mutations n = 24, fusB n = 2, fusC n = 36) were found in isolates from all countries bar U.S.A. and correlated with higher MICs (≥1 mg/L), although 4 SP isolates had MICs of 0.06 mg/L despite carrying fusC. CHX MICs did not correlate with qacA/B (n = 2) and smr (n = 5), which were found in SEUK SA, and SP from NUK and U.S.A.
CONCLUSIONS
Increased FA MICs were frequently associated with fusA mutations and fusC, and this is the first account of fusB in SP. Despite novel description of qacA/B in SP, gene presence did not correlate with CHX MIC. Selection pressure from clinical use might increase prevalence of these genetic determinants, but clinical significance remains uncertain in relation to high skin concentrations achieved by topical therapy.
Topics: Animals; Anti-Bacterial Agents; Bacterial Proteins; Chlorhexidine; Disinfectants; Dogs; Drug Resistance, Multiple, Bacterial; Finland; Fusidic Acid; Germany; Methicillin Resistance; Microbial Sensitivity Tests; Peptide Elongation Factor G; Pyoderma; R Factors; Staphylococcus; Staphylococcus aureus; United States
PubMed: 31023224
DOI: 10.1186/s12866-019-1449-z