Pyoderma gangrenosum in ulcerative colitis: considerations for an early diagnosis

doi:10.1136/bmj.331.7528.1323

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K I Papageorgiou (papageorgiouk@doctors.org.uk), senior house officer1,
R G Mathew, senior house officer1,
M G Kaniorou-Larai, fellow in plastic surgery2,
A Yiakoumetis, consultant plastic surgeon2

¹ Department of Ophthalmology, Broomfield Hospital, Chelmsford, CM1 7ET
²Department of Plastic and Reconstructive Surgery, “G. Gennimatas” 6th IKA Oncological Hospital, 11473, Athens, Greece

Correspondence to: K I Papageorgiou

Accepted 3 May 2005

Introduction

Pyoderma gangrenosum is a poorly understood destructive cutaneous disorder, characterised by progressive painful ulceration.1 Accurate epidemiological data are missing, but in half of cases there is an associated underlying disease, most commonly inflammatory bowel disease, rheumatological and haematological disorders.2 3 As pyoderma gangrenosum is not commonly encountered by clinicians, the diagnosis of such lesions is not always straightforward. We report the case of a man with ulcerative colitis, who presented with a non-healing ulcer of traumatic origin unresponsive to conservative and surgical management. This case emphasises the importance of detailed history taking and the consideration of pyoderma gangrenosum as a differential of such lesions in patients with a background of related systemic disease.

Case report

A 49 year old man was referred to the department of plastic surgery with a two week history of a post-traumatic, painful, and expanding ulcerated area on the anteromedial aspect of the left lower limb. The patient had a past medical history of ulcerative colitis, which he reported to be in remission for several years and he was currently not on any medication, including steroids. On initial presentation, the …