Images in Clinical Practice

Indian Pediatrics 2000;37: 1277.

Pyoderma Gangrenosum

A 10-month-old male child presented with skin lesions of 20 days duration. The lesions, which started on the face, involved the thighs, buttocks and extremities within the next 5 days. They started as small papules which became pustular, increased in size, ulcerated and discharged pus. There was also involvement of lips and oral cavity. There were multiple erythematous nodules, bullae and ulcers with dusky purple borders and undermined edges. The base of the ulcer showed subcutaneous fat with granulation and necrotic material. Multiple cribriform scars were also seen (Fig. 1). The infant had associated bronchopneumonia. Skin biopsy revealed hyperkeratosis with multiple keratotic plugging. Dermis showed mild perivascular round cell infiltration and neutrophilic, lymphocytic and macrophage infiltration. This infiltrate extended to the subcutaneous plane.

The child was started on Inj. Ceftazidime (to treat secondary infection) and Betamethosone drops. All lesions started healing and the child was discharged after a 25 day stay in the hospital.

Pyoderma gangrenosum is a rare disease in infants, 50% are idiopathic and the others may be immune mediated. In older age group, it is associated with inflammatory bowel disease, Chronic active heptitis, chronic persistent hepatitis, polyarthritis (rheumatoid arthritis) and myeloproliferative disease. Corticosteroids (prednisolone 1 mg/kg/day - pulse therapy) with or without intralesional therapy is the mainstay of treatment. In refractory cases, cytotoxic agents are beneficial. Other drugs used include Dapsone, Sulfapyridine and Hyperbaric Oxygen. Prognosis is usually good with rare exacerbations and remissions.

Fig. 1. Photograph showing multiple lesions.

M.D. Ravi,
Nesmal Sanju,
Department of Pediatrics,
Jagadguru Sri Shivaratheeshwara
Medical College and Hospital,
Mysore 570 004, India.