A Case of Pyoderma Gangrenosum Associated with Inactive Ulcerative Colitis

Cho, Hwoang Lee; Chang, Young Woon; Cho, Yong Seon; Dong, Seok Ho; Kim, Hyo Jong; Kim, Byung Ho; Lee, Joung Il; Chang, Rin

Abstract

Ulcerative colitis is assoicated with various extraintestinal manifestations. Skin lesions are occurring in 9-19% of patients with ulcerative colitis. Among these lesions erythema nodosum is the most common and pyoderma gangrenosum is the most severe. While pyoderma gangrenosum occurs more frequently in patients with ulcerative colitis, erythema nodosum occurs more frequently in patients with Crohn's disease. The overall incidence of pyoderma gangrenosum is approximately 1-5% of patients with inflammatory bowel disease (IBD). Painful lesions usually appear on the pretibial area, and develop in patients with long-standing IBD, but occasionally precede the diagnosis of IBD and may occur after colectomy. Lesions are discrete ulcers with a necrotic base and begin as small painful pustules, which coalesce into a fluctuant sterile abscess within days. Usually pyoderma gangrenosum is present for weeks to months, occasionally persisting for more than 1 year. The recurrence rate is reported in about 33% of all cases. Lesions usually appear in patients with pancolitis and respond to treatment of systemic corticosteroids, antimicrobial agents, and occasionally are treated with cyclosporine or surgery. We experienced a case of pyoderma gangrenosum developed on the left pretibial area in a patient with inactive ulcerative colitis, and completely healed with oral prednisolone, antimicrobial agents and external dressing. Subsequently, we report this case with a review of corresponding literature.