Pyoderma gangrenosum preceding the diagnosis of ulcerative colitis: a case report

Abstract

Pyoderma gangrenosum (PG) is an inflammatory, neutrophilic dermatosis characterised by rapid progression, ulceration, necrosis, and cribriform scar formation. It may be associated with inflammatory, haematologic, and rheumatologic conditions. A 32-year-old male patient from Gurage Zone, Ethiopia, presented with long-standing skin ulceration over his lower limbs. After about eight and a half years, he developed symptoms of ulcerative colitis (UC). His complete blood count revealed anaemia (haemoglobin 9.5 g/dl) and thrombocytosis. The erythrocyte sedimentation rate (ESR) was also elevated. A colonoscopy revealed evidence of pancolitis with backwash ileitis. Histology from colonic biopsy revealed chronic inflammatory cells and crypt abscesses consistent with the UC diagnosis. Later, the patient was started on prednisolone (1 mg/kg/day) and azathioprine, improving the gastrointestinal (GI) symptoms without significant changes to the skin lesions. It is important to note that UC can occur before or after the onset of PG, and a low threshold should be maintained for investigating UC in patients with PG.