抄録
Ulcerative pyoderma gangrenosum (PG) is characterized by proliferative, necrotic, deep, and undermined ulcers that occur either singly or as multiple lesions on the lower extremities of the body. We report the case of a 68-year-old man who was initially treated for a diabetic ulcer. However, based on the characteristic clinical features, including pathergy, severe pain, and edematous erythema surrounding the ulcers, a diagnosis of PG was established. Systemic corticosteroids were not administered because of patient-specific factors. Alternative systemic therapies, including adalimumab, granulocyte and monocyte adsorption apheresis, and cyclosporine, were sequentially initiated. However, disease control was not achieved, and his condition progressively worsened, thus resulting in death 14 months after the initial presentation and approximately 26 months after the disease onset. PG demonstrates a broad spectrum of severity, ranging from mild, self-limiting disease to severe, potentially fatal presentations. Because diagnostic uncertainty often delays treatment initiation, the early recognition of PG and prompt initiation of appropriate systemic therapy are critical, particularly in cases of progressive and refractory ulcers.
(a) Initial presentation of the patient. An ulcer with adherent eschar and slough. (b) Day 41. After debridement and negative-pressure wound therapy, the wound bed showed adequate preparation. (c) Day 62. After split-thickness skin grafting. (d) Day 97. Tape-induced dermatitis rapidly progressed to ulceration. (e) Day 181. After three doses of adalimumab, the surgical site epithelialized; however, deep ulcers developed in the surrounding tissues. (f) Day 258. Ulcers were observed in the right lateral malleolus during granulocyte and monocyte adsorption apheresis. (i) Left, (ii) Right. (g) Day 324. After the initiation of cyclosporine, the left side improved, whereas the right side worsened. (i) Left, (ii) Right. (h) Day 350. The ulcers progressively enlarged over time. (i) Day 406. Multiple deep ulcers were observed extending from the lower leg to the dorsum of the foot. (i) Left, (ii) bilateral, and (iii) right.
