Intest Res.  2014 Apr;12(2):153-156. 10.5217/ir.2014.12.2.153.

Peritonsillar Involvement in Pyoderma Gangrenosum associated with Ulcerative Colitis

• Byeon YM
• Lee J
• Lee SJ
• Park CJ
• Yun NR
• Kim YD
• Park CG
• Kim MW

• KMID: 2284901
• DOI: http://doi.org/10.5217/ir.2014.12.2.153

Abstract

Peritonsillar abscess is a common deep throat infection. Early diagnosis and prompt, appropriate management of a peritonsillar abscess prevents mortality. A 45-year-old woman on steroids for an ulcerative colitis (UC) exacerbation presented with sore throat and multiple skin ulcers on her left forearm and right foot. Computed tomography of the neck revealed a peritonsillar abscess. Gram staining and culture of the abscess were negative, and a skin biopsy suggested pyoderma gangrenosum (PG). The final diagnosis was peritonsillar involvement of steroid-refractory PG-associated UC. The patient showed a complete response to infliximab. Here, we report a case of successful infliximab treatment for peritonsillar involvement of steroid-refractory PG-associated UC.

Keyword

Pyoderma gangrenosum; Ulcerative colitis; Peritonsillar abscess

MeSH Terms

Abscess
Biopsy
Colitis, Ulcerative*
Diagnosis
Early Diagnosis
Female
Foot
Forearm
Humans
Infliximab
Middle Aged
Mortality
Neck
Peritonsillar Abscess
Pharyngitis
Pharynx
Pyoderma Gangrenosum*
Skin
Skin Ulcer
Steroids
Steroids

Figure

• 

  Fig. 1 Colonoscopic finding. Colonoscopy shows diffuse ulcers and nodularity with mucosal edema and hemorrhage at the sigmoid colon and rectum.

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  Fig. 2 Skin lesions and biopsy finding. (A) A large ulcer with edema, exudate, and pus on the left forearm and foot (B) Massive lymphocytic and neutrophilic infiltration (arrow) of the dermal interstitium (black star) suggestive of pyoderma gangrenosum (PG) (H&E stain, ×100).

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  Fig. 3 Neck CT findings. (A) Computed tomography(CT) of the neck shows a hypodense mass with gas formation (arrow) suggestive of peritonsillar abscess formation. (B) A follow-up CT of the neck 3 weeks after infliximab treatment shows that the A B previous abscess has disappeared.

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  Fig. 4 Follow-up of skin lesions. Three weeks after infliximab treatment, the ulcers reduced in size and are covered with regenerated epithelium.

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