| ObjectivesPyoderma gangrenosum(PG)is a rare autoimmune disease,due to the lack of specific clinical manifestations,auxiliary examinations and unified diagnostic criteria,misdiagnosis occurs from time to time.Skin lesions can be single or multiple,and patients with single lesion are rare and clinically more likely to be misdiagnosed.By analyzing the clinical characteristics,complicated systemic diseases,histopathology,diagnosis and treatment of PG with single lesion as the first symptom,this study aims to raise the awareness of specialists and related professions on the disease,and decrease the possibility of misdiagnosis.MethodsThis study reported 4 cases of misdiagnosed PG with single lesion as the first symptom which admitted to Qilu Hospital of Shandong University from 2015 to 2019.Then had a literature review from PUBMED,WANFANG and CNKI,and analyzed 164 cases from 2010 to 2019 with detailed clinical data.SPSS 25.0 was used for statistical analysis,P<0.05 was considered statistically significant.ResultsClinical data of 4 cases in our hospital:1.General information:2 males and 2 females.Age range from 13ys to 47ys.2.Causes:2 cases had no obvious causes,2 cases had a history of minor trauma.3.Clinical characteristics:2 cases occurred on the face,2 cases occurred in the lower extremities.Lesions were initially erythema,papules,pustules or redness,which formed painful ulcers after rupture,part of the edge is uplifted and sneaky destroyed.4.Diagnosis and treatment:2 cases were first admitted to department of dermatology,2 cases were first admitted to department of surgery.4 cases were misdiagnosed as infection and failed to respond to antibiotics,with the completion of histopathology and other examinations,the diagnosis was revised as PG,then corticosteroids and other drugs were given for improvement.Clinical data of 164 cases from domestic and foreign literature:1.Gender:75 males and 89 females were included,Male:female=1:1.2.Age range from lys to 90ys,most cases occurred between 40ys-70ys(56.7%).The average age of male is 54.3±19.2ys,and 47.6±18.2ys for female,the difference was statistically significant(P=0.025).2.Causes:44.5%of the patients have causes before the onset,including surgical trauma(28.0%),other trauma(14.6%)and medicine(1.8%)mainly.3.Clinical manifestations:Skin lesions tend to affect the lower limbs,trunk,head and face,vulva and upper limbs(45.1%?24.4%?15.2%?7.9%?7.3%).Classical PG,vegetative PG,bullous PG and pustular PG accounted for 94.5%,2.4%,2.4%and 0.6%,respectively.All patients felt pain in different degrees,23.8%of the patients showed isomorphism,and 19.5%had fever.4.Complicated systemic diseases:53.1%of the patients have complicated systemic diseases,most of which are inflammatory bowel disease,accounting for 18.9%,the second is hematological disease,accounting for 16.5%.Most of the patients had complicated systemic diseases first and then developed PG.The proportion of complicated systemic diseases is the highest in the age of 50ys-60ys(66.7%),and there was no significant difference between male and female patients(P=0.575).Patients induced by surgical trauma have a low correlation with systemic diseases(P=0.003).Most of the combined tumors were hematologic tumors,while solid tumors were few,and combined tumors are more likely to be male than female(P<0.001).5.Misdiagnosis:64.0%of the patients were misdiagnosed at the first diagnosis,and bacterial infection was the most common misdiagnosed disease,The misdiagnosis rate of head and face,trunk,upper extremity,vulva and lower extremity is 80.0%,57.5%,91.7%,76.9%,55.4%respectively,the difference was statistically significant(P=0.029).The misdiagnosis rate of dermatology department is lower than that of non-dermatology department(P<0.001).The diagnosis of misdiagnosed patients at the first diagnosis mainly depended on the exclusion of other diseases,completion of histopathology and effect of immunotherapy.6.Auxiliary examination:Nonspecific,but it helps to rule out other diseases.Especially histopathology is of great significance for diagnosis and differential diagnosis.7.Treatment:Corticosteroids were the most common drugs.In severe cases,one or more combinations of corticosteroids,cyclosporine,gamma globulin or biologics may be used.Secondary infection was treated with sensitive antibiotics.8.The days of healing of skin lesions:In 68 healing cases with complete course information,23 were first diagnosed,with an average healing time of 104.2±93.8 days.And 45 were first misdiagnosed,with an average healing time of 172.9± 162.7 days,The difference was statistically significant(P=0.049).9.Prognosis:20.0%(18/90)relapsed,6.7%(6/90)died,and most of whom die from infections or systemic diseases.Conclusion1.For PG with single lesion as the first symptom,Most cases occurred between 40ys-70ys,Male:female=1:1.2,the age of onset in male is higher than that of female.2.PG is easily induced by surgical trauma.The typical lesion is painful ulcer,but not specific.3.More than half of the patients are associated with complicated systemic diseases,most of which are inflammatory bowel disease and hematological disease.Patients with tumors are more likely to be male,and more common in the hematologic system,while solid tumors are rare.4.PG is often misdiagnosed and is most easily misdiagnosed as bacterial infection.The misdiagnosis rate of dermatology department is lower than that of non-dermatology department.The lack of understanding of the disease,and the neglect of relevant examinations are easy to cause misdiagnosis and missed diagnosis.5.Combined with clinical and timely improvement of skin lesion histopathology and other related examinations are helpful for early diagnosis.6.Early diagnosis and early intervention can shorten the healing time of skin lesions. |
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