PUSTULAR PYODERMA GANGRENOSUM AND INFLAMMATORY BOWEL DISEASE – HEALING AFTER PROCTOCOLECTOMY

Abstract

We present the case of a 67-year-old patient observed with multiple painful violaceous plaques with central pustules on distal lower limbs, rapidly transforming into deep ulcers with infiltrated undermined borders and centrifuge progression, associated with mucous bloody diarrhea, oral erosions and hyperthermia in the previous three months. Histopathologic skin examination was consistent with the diagnosis of pyoderma gangrenosum (PG). Subtotal colonoscopy showed a severe continuous rectocolitis, consistent with unspecific inflammatory bowel disease (IBD). Due to colonic perforation, the patient was submitted to left colectomy, and afterwards to total proctocolectomy. Treatment with topical corticosteroids was performed and complete ulcer healing was observed three months after surgery, without recurrence in the following 2 years. Pustular PG is a rare condition; the relevance of this case is supported not only by the synergic evolution of severe pustular PG and IBD, but also by the prompt regression of the former after proctoco- lectomy.

KEYWORDS – Pyoderma Gangrenosum; Inflammatory Bowel Diseases; Proctocolectomy.