Case report C ASE REPOR T :


Pyoderma gangrenosum associated with melanoma


Pyoderma gangrenosum – a rare, neutrophilic dermatosis – is associated with diseases including inflammatory bowel disease, arthritis and haematologic disease. This case story describes an unusual association between pyoderma gangrenosum and malignant melanoma. Clinicians should consider malignant melanoma in all patients with pyoderma gangrenosum.


affects the lower extremities of adults aged 25–54 years.[1,2] There are four main clinical types of PG: (i)


P


ulcerative; (ii) pustular; (iii) bullous; and (iv) vegetative (2). In addition, peristomal PG is known.[2,3]


These variants of PG can be linked to


specific associated conditions in approximately 50% of patients.[2]


diseases are inflammatory bowel disease (IBD), arthritis and haematologic disease.[1,4,5] In the present case, we describe a female


patient with PG associated with malignant melanoma as an unusual clinical presentation. We emphasize the importance of diagnosing the PG-associated diseases in time and initiating the necessary treatment.


CASE REPORT In June 2010 a 59-year-old woman was referred to the authors’ institution with a 14-day history of spontaneously developed, large, exuding wounds on her legs. The patient reported a sore, slightly elevated bruising on the left lower leg as the initial area of concern. A couple of days later, she developed similar bruising over her right hip. During the days that followed, these two areas deteriorated into large, exuding wounds: a 10 cm x 10 cm ulcer, sharply defined with a red– purple edge on the left lower leg [FIGURE 1]; and a 12 cm x 10 cm ulcer on the right hip – similar in appearance to the one on the lower leg, but more necrotic. On presentation to the authors’ institution, thorough physical examination of the patient


The most common associated


yoderma gangrenosum (PG) is a rare, non-infectious, ulcerating, neutrophilic dermatosis, that most frequently


revealed no pathological findings, beyond the described skin changes. The ulcers were clinically suggestive of PG.


After blood samples and a skin biopsy were taken, treatment with prednisolone (40 mg per day) and painkillers was commenced. Wound care with local steroids, foam dressings, and absorbent bandages (changed daily) was also undertaken. Laboratory tests included complete


differential blood count, electrolytes, liver enzymes, Wassermann reaction, antinuclear antibody, rheumatoid factor, antineutrophil cytoplasmic antibodies, immunoglobulines, and urine analysis. The aberrant blood samples showed elevated C-reactive protein (CRP) of 126 mg/L, and erythrocyte sedimentation rate of 68 mm/hour, thrombocytes of 622 x 109/L, leukocytes of 22 x 109/L with a predominance of neutrophils of 19 x 09/L, and microcytic anaemia with a haemoglobin level of 6.2 mmol/L.


Authors: Caroline Carøe, Karsten Fogh


Figure 1. Pyoderma gangrenosum on the patient’s left lower leg (10 cm x 10 cm ) at presentation. Note the sharply defined, red–purple wound edge.


Wounds International Vol 5 | Issue 2 | ©Wounds International 2014 | www.woundsinternational.com


Caroline Carøe is a Resident Physican and Karsten Fogh is an Associate Professor. Both are based at the Department of Dermato- Venerology, Aarhus University Hospital, Aarhus, Denmark.


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