Pioderma gangrenoso ulceroso asociado a artritis reumatoide: reporte de caso

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Abstract

ResumenEl pioderma gangrenoso corresponde a una dermatosis crónica inflamatoria rara, cuya etiología y patogénesis es aún incierta, aunque factores inmunológicos y disfunción neutrofílica parecen desempeñar un papel importante. Se presenta en la mayoría de los casos asociada a enfermedad sistémica no infecciosa, como artritis reumatoide, malignidad hematológica y enfermedad inflamatoria intestinal (EII). Es más común en mujeres entre la tercera y quinta década de la vida y puede presentarse como cuatro variantes clínicas distintas que conllevan a ulceración de la piel, con topografía predominante a nivel de extremidades inferiores. Su diagnóstico es meramente clínico y de exclusión y el tratamiento a menudo amerita medidas locales y sistémicas.Se describe aquí el caso clínico de una paciente femenina de 38 años con pioderma gangrenoso variante ulcerativa, asociado a artritis reumatoide, quien presentó excelente evolución clínica posterior a instaurado el tratamiento esteroideo sistémico.

Translated abstract

AbstractPyoderma gangrenosum is a rare chronic inflammatory dermatosis of unknown etiology and pathogenesis, although immunological factors and neutrophil dysfunction are believed to play an important role. In most cases it is associated with non-infectious systemic diseases such as rheumatoid arthritis, hematologic malignancies and inflammatory bowel disease. It is more common in women with a peak incidence between the third and fifth decades of life and it may present in four distinct clinical forms, all leading to ulceration of the skin, with involvement predominantly of the lower limbs. The diagnosis is based on the clinical manifestations and exclusion of other entities. Frequently systemic and local therapy is required.The clinical case of a 38 year old woman with ulcerative pyoderma gangrenosum associated with rheumatoid arthritis who had an excellent response to treatment with systemic steroids is described.

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Pyoderma gangrenosum: an updated review.

Jason Miranda, A Gravina, E Ruocco … (2009)

Pyoderma gangrenosum is a rare, ulcerative, cutaneous condition. First described in 1930, the pathogenesis of pyoderma gangrenosum remains unknown, but it is probably related to a hyperergic reaction. There are various clinical and histological variants of this disorder. Pyoderma gangrenosum often occurs in association with a systemic disease such as inflammatory bowel disease, rheumatologic disease, paraproteinaemia, or haematological malignancy. The diagnosis, mainly based on the clinical presentation and course, is confirmed through a process of elimination of other causes of cutaneous ulcers. Local treatment may be sufficient for mild disease, while for severe cases, systemic immunosuppressants are the mainstay. Long-term treatment with these agents is often required, but this can expose patients to adverse side-effects.