Sir, Vegetating pyoderma gangrenosum (VPG) is a clinical variant of PG clinically characterized by chronic, hypertrophic, inflammatory lesions affecting extensive skin surface areas.1 Histologically, VPG shows characteristic features of granulomatous disease including necrosis, capillary thrombosis and massive cell infiltration by polymorphonuclear neutrophils, epithelioid cells and giant cells.2 Apart from local and systemic antimicrobial therapies, immunosuppressive and immunomodulatory treatment regimens such as systemic administration of glucocorticoids, azathioprine, ciclosporin, cyclophosphamide, tacrolimus (FK 506)3 and high‐dose immunoglobulins4 have been shown to be beneficial for VPG. We report a 39‐year‐old man with a 10‐year history of chronic VPG resistant to these standard treatments. His clinical status deteriorated constantly. Multiple disseminated, heavily indurated and fistulating lesions (Fig. 1) severely reduced his quality of life and led to frequent hospitalizations of long duration and finally to destabilization. The cutaneous lesions presented as multiloculated necrotic ulcerations (Fig. 2A). Pus was exprimable at most of the lesions and fistulations occurred especially in the gluteal region (Fig. 2B) and in the right axilla. Furthermore, the patient reported severe pain in multiple joints, which were radiologically confirmed to be of arthritic origin.
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Jenne et al. (2004) studied this question.