METACHRONOUS AND ECTOPIC OCCURRENCE OF PYODERMA GANGRENOSUM IN A PATIENT UNDER MEDICAL OBSERVATION FOR CROHN'S DISEASE

Pyoderma gangrenosum is an ulcerative dermal disorder of unknown origin that occurs in patients with inflammatory diseases of the intestine in a low frequency. This time we experienced a case of metachronous and ectopic occurrence of pyoderma gangrenosum in a patient under medical observation for Crohn's disease. A 22-year-old man who was staying at the internal medicine in our hospital for the purpose of controlling aggravated Crohn's disease was found having an ulcerative dermal lesion in the left anterior tibial region. In spite of incision for drainage, administration of antibiotics, and debridement, the lesion became worse so that the patient was transferred to the department. Based on negative results in biological culture of pus and macroscopic findings, the diagnosis of pyoderma gangrenosum was made. External and internal uses of steroids were started. Remarkable remissions in inflammatory findings and dermal lesion were obtained and the patient was discharged from the hospital about 2 months after the treatment. Thereafter, a recurrence to the temporal region occurred, but it was relieved by increasing the dose of steroids. It is inferred that pyoderma gangrenosum will increase with a recent increase in Crohn's disease. When we encounter intractable dermal ulcerative lesion, a possibility of the disease must be kept usually in mind, and medical treatment including steroids should be preceded to surgery to minimize the surgical stress.