Cases reported "Pyoderma"

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1/9. Sweet's syndrome progressing to pyoderma gangrenosum--a spectrum of neutrophilic skin disease in association with cryptogenic cirrhosis.

    A 78-year-old Caucasian woman developed Sweet's syndrome which progressed over 3 weeks to pyoderma gangrenosum and subcorneal pustule formation. In spite of treatment the patient died and post-mortem examination revealed cryptogenic cirrhosis which could have explained the spectrum of neutrophilic skin disease observed in this patient.
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2/9. pyoderma gangrenosum with pulmonary involvement.

    A 60-year-old woman had a typical pyoderma gangrenosum with monoclonal IgA gammopathy and atrophic gastritis. Two years after the onset of her skin disease, she had evidence of pulmonary abscesslike involvement. Corticosteroid therapy led to healing of skin and lung diseases. This case stresses the multisystemic manifestations of neutrophilic dermatoses with special attention to pulmonary involvement.
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3/9. pyoderma gangrenosum involving the head and neck.

    In six patients with pyoderma gangrenosum, the head and neck region was a major site of ulcerative skin disease. In two patients, the disease was limited to this anatomic site. Corticosteroids were effective therapy in five cases. In one case, occurring in association with ulcerative colitis, total proctocolectomy was required to control ulcerative scalp disease. Detailed histologic examination of a primary lesion in one case with 0.5-micron sections demonstrated morphologic evidence of mast cell activation, suggesting that mast cells may contribute to the pathogenesis of the inflammatory process in pyoderma gangrenosum.
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4/9. pyoderma gangrenosum and myelodysplasia.

    pyoderma gangrenosum has been recognized occurring in association with acute and chronic leukaemia. More recently it has been described in patients with myelodysplasia (Jacobs, Palmer & Gordon-Smith 1985). We report a case of pyoderma gangrenosum in a patient with a preceding history of myelodysplasia, illustrating the problem of controlling the skin disease in this condition and the eventual transformation of the myelodysplasia into acute leukaemia. Treatment of the leukaemia resulted in improvement of the skin lesions.
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5/9. Malignant pyoderma.

    Malignant pyoderma is a destructive, ulcerating skin disease that occurs chiefly in young adults. Only eight cases of this rare disease have been reported. The head and neck have been involved in all cases, and a predilection for the periauricular region has been noted in several of the cases. Although the disease is progressive and chronic, responses to high-dose systemic corticosteroids have been noted, but usually a flare is associated with a reduction in dose. An additional case is described in which therapy with isotretinoin and sulfapyridine led to complete remission.
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6/9. pyoderma gangrenosum involving the eyelid.

    A 62-year-old man was seen with an ulcer of the left upper eyelid of two weeks' duration. Over the previous 40 years, similar ulcers had intermittently developed elsewhere on his skin and spontaneously resolved over several months leaving atrophic scars. A biopsy specimen of the eyelid lesion showed epidermal ulceration with acute inflammation and liquefactive necrosis of the underlying dermis. Microorganisms and vasculitis were not present. On the basis of the clinical history and a compatible biopsy specimen, the diagnosis of pyoderma gangrenosum was made. This is an uncommon, idiopathic, ulcerating skin disease that may also have ocular manifestations. Eyelid ulcers have not previously been reported, to our knowledge. The diagnosis is established by clinical history and exclusion of other causes of ulceration.
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7/9. Chronic pyoderma in splenectomized patient.

    This is a report of a case with a chronic peculiar intractable pyoderma. The process started a year after splenectomy because of trauma. In the absence of an apparent other reason, we assume that a relationship exists between the operation and the skin disease.
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8/9. Malignant pyoderma.

    Malignant pyoderma is a rare, chronic, destructive ulcerating skin disease of unknown cause that affects young adults, usually males. In the seven previously reported cases, the lesions were distributed mainly about the head and neck region, and some were associated with neurological disturbances. The disease is progressive but responds to high doses of systemically administered steroids. We here describe an additional case and a follow-up of a previously reported case that was managed successfully with corticosteroid and cyclophosphamide therapy.
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9/9. pyoderma gangrenosum: clinical and laboratory findings in 15 patients with special reference to polyarthritis.

    Fifteen consecutive patients with PG have been studied during the period 1971-78. Systemic disease was found in 13 of the patients and preceded the skin disease in 10 patients by 1-25 years. Only two patients had ulcerative colitis. One patient had paroxysmal nocturnal hemoglobinuria and three patients had an IgA myeloma. Eight patients had polyarthritis; this was classical seropositive rheumatoid arthritis in two patients, and a seronegative inflammatory polyarthritis in six patients. Four patients had an unusual progressive erosive seronegative polyarthritis without evidence of granulomatous bowel disease, psoriasis, genital, urinary tract or eye disease. In three of these four patients the arthritis preceded the PG. synovial fluid analysis showed depressed complement levels and in one patient deposits of immunoglobulins and complement were demonstrated in the synovial membrane. The course of the arthritis was progressive with development of disabling joint deformities and erosive destruction of joints, despite treatment with penicillamine, corticosteroids and nonsteroidal anti-inflammatory drugs. One other patient had severe degenerative joint disease and chondrocalcinosis in association with a seronegative inflammatory polyarthritis, and another patient had ulcerative proctitis and severe degenerative joint disease secondary to chronic seronegative inflammatory polyarthritis. None of the patients had colitic arthritis, but in view of the association between PG and ulcerative colitis, some patients previously reported with PG and joint disease may have been suffering from the arthritis of ulcerative colitis. PG developed at the site of skin trauma in six patients. The natural history of the skin disease ran one of two courses: an acute, progressive course in which the ulcers rapidly enlarged until arrested by treatment; and a chronic course in which the lesions extended slowly and which after a period of weeks began to show signs of spontaneous healing. In only the patients with ulcerative colitis was there any correlation between the activity of the associated disease and the onset and progression of the skin disease. serum complement levels were normal and no circulating cryoprecipitable immune complexes were found. skin histology showed no evidence of vasculitis and direct immunofluorescence examination of involved skin was negative for IgG, IgM, IgA and C3. No consistent abnormality of cell-mediated immunity or neutrophil function was found and no significantly increased prevalence of any HLA antigen type was noted. Twelve patients have been treated with systemic corticosteroids. Six of these patients developed serious steroid complications and four patients have died, all from complications of steroid therapy.
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