Recurrent and treatment-resistant pyoderma gangrenosum, secondary to hidden underlying breast cancer
DOI:
https://doi.org/10.15305/ijrci/v3i1/162Keywords:
recurrent pyoderma gangrenosum, breast carcinoma, parenteral pulse steroidsAbstract
Pyoderma gangrenosum (PG) is a rare ulcerative disorder of the skin associated with underlying diseases, such as rheumatoid arthritis, inflammatory bowel disease and hematological malignancies. However, there have been very few reports of association of PG with solid organ malignancies. We report here the case of a 37-year-old lady with a chronic non-healing ulcer of the thigh, who repeatedly underwent multiple debridements, followed by two failed grafts, which was later diagnosed as PG. Initially, she failed to respond to oral steroids, but responded well with intravenous methylprednisolone pulse. However, she later presented with a breast mass with bone metastasis and recurrence of PG ulcer. Diagnosis and treatment of the underlying occult malignancy along with that of PG at an initial stage would have prevented the recurrence and avoided a serious consequence like metastasis. The case study underscores the association of PG with serious conditions, such as malignancy, and the necessity to conduct prompt and thorough analysis in such cases.
References
Powell FC, Hackett BC. Pyoderma Gangrenosum. In: Wolff K, Goldsmith LA, Katz SL, Gilchrist BA, Paller AS, Leffell DJ, editors. Fitzpatrick’s Dermatology in General Medicine, 7th ed. Vol.1. New York: Mc Graw Hill; 2007.p.296-302.
Bhat RM, Nandakishore B, Sequeira FF, Sukumar D, Kamath GH, Martis J, et al. Pyoderma Gangrenosum: An Indian prespective. Clin Exp Dermatol 2011;36:242-247.
Miller J, Yentzer BA, Clark A, Jorizzo JL, Feldman SR. Pyoderma gangrenosum: a review and update on new therapies. J Am Acad Dermatol 2010;62:646-654.
Ruocco E, Sangiuliano S, Gravina AG, Miranda A, Nicoletti G. Pyoderma gangrenosum: an updated review. J Eur Acad Dermatol Venereol. 2009;23:1008-1017.
Moschella S, Davis M. Neutrophilic Dermatoses. In: Bolognia JL, Jorizzo JL, Rapini RP, editors. Dermatology. Madrid: Elsevier Espa˜na S.A; 2008. p. 383-387.
Garcia-Rabasco AE, Esteve-Martinez A, Zaragoza-Ninet V, Sanchez-Carazo JL, Alegre-de-Miquel V. Pyoderma gangrenosum associated with hidradenitis suppurativa: a case report and review of the literature. Actas Dermosifiliogr. 2010;101:717-721.
Su WP, Davis MD, Weenig RH, Powell FC, Perry HO. Pyoderma gangrenosum : clinicopathological correlation and proposed diagnostic criteria. Int J Dermatol 2004:43:790-800.
Kanno T, Ito M, Tsuji H, Kawase N, Taki Y. A case of pyoderma gangrenosum involving the prostate gland after radiation therapy for prostate cancer. Hinyokika Kiyo. 2002;48:565-568.
Gateley CA, Foster ME. Pyoderma gangrenosum of the breast. Br J Clin Pract. 1990;44:713-714.
Simon H, Metges JP, Lucas B, Malhaire JP. Pyoderma gangrenosum and breast cancer: a new case. Ann Med Interne. 2000;151:314-315.
Sharma AK, Horgan K, Holt P. The management of acute pyoderma gangrenosum of the breast with a coincidental invasive breast cancer. J Dermatol Treat. 1994;5:215-217.
Davis MD, Alexander JL, Prawer SE. Pyoderma gangrenosum of the breast precipitated by breast surgery. J Am Acad Dermatol. 2006;55:317-320.
Rietjens M, Cuccia G, Brenelli F, Manconi A, Martella S, De Lorenzi FA. Pyoderma gangrenosum following breast reconstruction: a rare cause of skin necrosis. Breast J. 2009;16:200-202.
Horner B, El-Muttardi N, Mercer D. Pyoderma gangrenosum complicating bilateral breast reduction. Br J Plast Surg. 2004;57:679–681.
Long CC, Jessop J, Young M, Holt PJ. Minimizing the risk of post-operative pyoderma gangrenosum. Br J Dermatol. 1992;127:45-48.
Crowson AN, Mihm Jr MC, Magro C. Pyoderma gangrenosum: a review. J Cutan Pathol. 2003;30:97-107.
Bhat RM. Pyoderma gangrenosum: An update. Indian Dermatol Online J. 2012;3:7-13.
Bhat RM. Management of pyoderma gangrenosum: An update. Indian J Dermatol Venereol Leprol. 2004;70:329-35.
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