A Case Of Vegetative Pyoderma Gangrenosum And A Review Of The Literature

Objective:Analysis clinical characterisics of vegetative pyoderma gangrenosum, investigate the methods how to deal with the disease, highlight the various features of this condition, in order to assist the diagnosis and treatment of the disease.Methods:Report a case of vegetative pyoderma gangrenosum, and review the literature on vegetative pyoderma gangrenosum at home and abroad from 1988 to now. There are 10 cases at home and 68 cases aboard. We collect the general information such as sex, age, clinical manifestations, laboratory findings, treatment options and prognosis of the reported cases, and then amalysis the etiology, pathogenesis, clinical manifestations, laboratory tests, histopatological examination and treatment.Result:The causes of vegetative pyoderma gangrenosum are not clear. There are many different features between vegetative pyoderma gangrenosum and pyoderma gangrenosum.(1) We report a case of vegetative pyoderma gangrenosum. Several superficial ulcers with vegetative exophytic margins and plaques were also present. Cribriform sinuses were on the plaque surfaces and ulcer bases. Pus discharged under pressure. Repeated smears and cultures were negative. Forearm incisional biopsy showed pseudoepitheliomatous hyperplasia and diffuse neutrophilic infiltration with microabscesses. Lesions markedly abated after systemic corticosteroid therapy.(2) Review the literature of the reported 10 cases of the patients at home, they are all cases of male. Review the literature of the reported 68 cases of patients abroad,35 cases of male,32 cases of female, male and female incidence rate ratio about 1.16.(3) Age:Of the cases at home, minimum 34 years old. maximum 82 years old. Of the cases broad, minimum 8 years old, maximum 85 years old, median age 53 years old, the average age 50.9 years old. Patients abroad were among on every age segment, while the peak age was 50-80 (50.0%)(4) Vegetative pyoderma gangrenosum is commonly found on the trunk(54.4%) and the lower limbs(23.5%).(5) 4 in 10 patients at home were associated with an underlying systemic disease. 25.8% of 68 cases abroad were associated with an underlying systemic disease.6 in 13cases over the age 70 abroad were associated with an underlying systemic disease.(6) The initial lesion of vegetative pyoderma gangrenosum is a nodule or plaque, solitary or multiple, which evolves to form superficial ulcers with a clean base and purple borders. The lesions can be exophytic, vegetative, slowly progressive, and relatively nonpainful. Cribriform sinuses were on the plaque surfaces and ulcer bases.(7) Histological appearances are also characteristic, but not specific. Histological appearances are also characteristic, but not specific. The "three-layered granuloma" consists of an inner zone of neutrophils and cell destruction, a mid-zone of histiocytes and giant cells, and an outer zone of plasma cells and vasodilation. Typically one sees sinus formation, neutrophilic abscesses and palisading granulomas.(8) Diagnosis of vegetative pyoderma gangrenosumis based on a typical history and clinical appearance. The history is classically of a slowly developing single lesion, classically on the trunk of an adult patient. Typically, the clinical appearance of this lesion is a slowly enlarging superficial lesion with vegetative borders and sinus tracks with or without the presence of pustules. Histological appearances are also characteristic, but not specific. Typically one sees sinus formation, neutrophilic abscesses and palisading granulomas and the so-called "three-layered granuloma" Negative bacterial and fungal cultures are necessary to exclude other infectious disorders, which can present in a similar fashion.(9) Vegetative PG is also often responsive to simple modes of therapy including topical and intralesional steroids and tacrolimus,7 in 10 cases at home and 20 in 68 cases (29.4%) aboard require oral corticosteroids, and 4 in 68 cases (5.9%) require cyclosporine. Infliximab. immunoglobulin and minocycline are also reported to be useful therapies.Conclusion:Vegetative pyoderma gangrenosum is commonly found on the trunk, and is more superficial ulceration with less undermining and a less violaceous hue to the borders, and the base is less often purulent than in classical PG with granulomatous histological change. Its behaviour is also less clinically aggressive and it is less often seen in the context of other associated disorders. Differentiating vegetative PG from other variants of PG is important. Vegetative PG is also often responsive to simple modes of therapy including topical and intralesional steroids and tacrolimus and less commonly requires oral corticosteroids and other immunosuppressive agents, unlike classical PG.