Visual System in Some Systemic Diseases
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Keywords:
Pathergy
Hypopyon
Erythema Nodosum
Pyoderma gangrenosum (PG) is an aseptic inflammatory neutrophilic dermatosis associated with painful ulcers and violaceous borders. Although a portion of cases are thought to be idiopathic, PG can be associated with many inflammatory diseases, most notably inflammatory bowel disease (IBD). Anatomically, PG in most young children is likely to develop on the head and neck or genital area, as opposed to the lower extremities in older children and adults. Lesions tend to demonstrate pathergy, where trivial inciting stimuli, such as trauma, are met with an abnormal response. In the treatment of PG, care should be taken to identify any underlying disease. Many topical and systemic agents have been trialled in an attempt to treat PG.
Pathergy
Pyoderma
Neutrophilic Dermatosis
Sex organ
Aseptic processing
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Pyoderma gangrenosum is an ulcerative disease of skin, the etiology of which is obscure. The authors are reporting a case of pyoderma gangrenosum of the abdominal wall that was initially misdiagnosed as a parietal wall abscess and exhibited characteristic pathergy after drainage. Diagnosis was made on clinical grounds and by the presence of pathergy. Abdominal wall pyoderma gangrenosum should be suspected in any patient with non-healing ulcerative lesions of the abdominal wall. The patient responded well to steroids with no recurrence seen in the follow up period. Pyoderma gangrenosum, a nuetrophilic dermatosis, is a rare ulcerative cutaneous disease. An immunological abnormality has been proposed as a possible mechanism. There are no specific clinical features seen with this disease. This has characteristic features of pathergy. Diagnosis relies on excluding other causes of ulcerative skin diseases. The occurrence of pyoderma gangrenosum at a surgical site is rare especially if there is no predisposing illness. Early diagnosis is essential to prevent pathergy. Corticosteroids are the main drugs used for treatment. A 28 year old female presented with painful swelling of the right abdominal wall and fever of 5 days duration for which she had received antibiotics but had no relief, with the worsening of symptoms and progressive increase of the swelling. On general physical examination, the patient had a dehydrated look and fever of 100 degrees Fahrenheit. Systemic examination was normal. Local examination revealed a tender swelling measuring 10 × 7.8 × 2.3 centimeter showing fluctuation, free from underlying structures, with prominence on Carnett’s test’s (leg raising test) in the right lower abdomen and was diagnosed as right parietal wall abscess, and had an incision and drainage. Thirty-six hours after incision and drainage, and despite improvement, there was an ulcer with pus and development of another pustule, and so the patient underwent another debridement. There was seen further worsening of symptoms despite the patient being on broad spectrum antibiotics, and the drainage of abscess were no improvement and the patient developed a third ulcerated lesion adjacent to the previous ones. The ulcers had a dirty floor with asymmetrical borders (Fig.1). Histopathological examination identified a non-specific mixed inflammatory cell infiltrate with
Pathergy
Pyoderma
Etiology
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BACKGROUND: Pyoderma gangrenosum (PG) is a rare ulcerative skin disease; its etiology is unknown, though it is often associated with autoimmune diseases. Pyoderma gangrenosum results in significant morbidity and exquisite pain that affects health-related quality of life. Wound healing is delayed, and patients often experience relapse. Pyoderma gangrenosum is susceptible to pathergy and deterioration with surgical intervention or other trauma; therefore, treatment includes atraumatic wound care, infection management, and local or systemic immunosuppression. CASE: We describe the use of modified negative pressure wound therapy (NPWT) with intralesional and topical steroids for the treatment of PG in a 15-year-old female patient with ulcerative colitis and a staged J-pouch ileoanal reconstruction. The patient and her family refused all systemic therapy due to prior steroid-associated weight gain. She was unable to tolerate conscious dressing changes, further complicating the treatment plan. Procedural interventions such as NPWT have been used previously for PG; however, they can cause wound pathergy and subsequent wound deterioration. Modified NPWT in conjunction with topical and intralesional steroids induced wound healing without producing pathergy. CONCLUSION: Timely recognition of PG is crucial to appropriate delivery of care. Modified NPWT and localized corticosteroid treatment were key to promoting wound healing in this case of pediatric PG.
Pathergy
Negative-pressure wound therapy
Wound care
Immunosuppression
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Erythema nodosum and pyoderma gangrenosum are common skin manifestations in inflammatory bowel diseases. Curiously, these two cutaneous features have seldom been reported to occur simultaneously. We present three patients affected with inflammatory bowel disease with concomitant erythema nodosum and pyoderma gangrenosum.
Erythema Nodosum
Concomitant
Erythema
Inflammatory Bowel Diseases
Neutrophilic Dermatosis
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Pyoderma gangrenosum (PG) is an inflammatory condition that causes neutrophilic infiltration of the skin and characteristic skin ulceration.1 More than half of patients develop PG in association with an underlying systemic disease.1 Its pathophysiology is complicated and not fully understood.1 PG can affect any part of the body, but it commonly affects the legs.2 The diagnosis of PG can be challenging and is often one of exclusion.3 PG exhibits pathergy, which is the development or worsening of a lesion at the site of trauma, and the presence of pathergy can help support the diagnosis of PG.
Pathergy
Debridement (dental)
Pathophysiology
Neutrophilic Dermatosis
Skin ulcer
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Erythema Nodosum
Inflammatory Bowel Diseases
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Pyoderma gangrenosum (PG) is a rare chronic ulcerative skin condition often associated with systemic disease. PG associated with pregnancy is an extremely rare presentation; only 9 other cases have been reported in the literature. We present PG in a pregnant patient (third trimester) with pathergy. No associated systemic disease was identified. Histology was consistent with PG and the lesions responded to intralesional triamcinolone therapy.
Pathergy
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Pyoderma gangrenosum is strongly associated with inflammatory bowel disease and exhibits pathergy, occurring at sites of previous minor trauma. A patient is presented with a 21 year history of extensive ulcerative colitis, who developed pyoderma gangrenosum and arthralgia while receiving high dose corticosteroids for active ulcerative colitis. The arthralgia exhibited pathergy affecting particularly the left temporomandibular joint, which was stressed by an asymmetric bite, and the left elbow, which had been fractured many years previously. This prompted the hypothesis that neutrophils in this condition may be marginated, as a result of increased stickiness of either the neutrophil or the vascular endothelium. The introduction of heparin therapy was associated with rapid resolution of the arthralgia, pyoderma gangrenosum, and ulcerative colitis.
Pathergy
Reactive arthritis
Pyoderma
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Pathergy
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Authors present case of a 28-year old woman with skin symptoms of pyoderma gangrenosum and ulcerative colitis seriously advanced. The patient benefited from wide resection of the colon and steroid therapy. The other patient was 23-year old woman with ulcerative colitis concomitant with skin changes of erythema nodosum. In this case steroid therapy gave also a very good effect. We tried to find pathogenetic connection between these diseases based on the reports from the medical literature.
Erythema Nodosum
Concomitant
Presentation (obstetrics)
Erythema
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