Indexed with PubMed and Science Citation Index (E) 
Users online: 2439 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
   Next article
   Previous article 
   Table of Contents
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
   [PDF Not available] *
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

  In this article
    Case Report

 Article Access Statistics
    PDF Downloaded4    
    Comments [Add]    

Recommend this journal

Year : 2001  |  Volume : 67  |  Issue : 5  |  Page : 259-260

Pyoderma gangrenosum and urinary tract infection

Department of Dermato-Venereology, Raiendra Hospital, Patiala - 147 001, India

Correspondence Address:
27, Bank Colony, Patiala - 147 001, India


A case of pyoderma gangrenosum is reported in a 52 - year - old man who had skin lesions without any association. On investigation urinary tract infection was detected. Treatment of UTI led to spontaneous healing of the lesions in short period thus avoiding the need of oral corticosteroids.

How to cite this article:
Chopra A, Jha A, Chopra D. Pyoderma gangrenosum and urinary tract infection. Indian J Dermatol Venereol Leprol 2001;67:259-60

How to cite this URL:
Chopra A, Jha A, Chopra D. Pyoderma gangrenosum and urinary tract infection. Indian J Dermatol Venereol Leprol [serial online] 2001 [cited 2020 Jun 4];67:259-60. Available from: http://www.ijdvl.com/text.asp?2001/67/5/259/11264

   Introduction Top

Pyoderma gangrenosum is a destructive, necrotizing, non - infective ulceration of skin, presenting as a furuncle - like nodule, pustule or haemorrhagic bulla.[1] Histopathologically it falls within spectrum of neutrophilic dermatoses.[2] A variety of systemic diseases are associated but in 10-30% of cases it occurs as an isolated cutaneous phenomenon.[3] Here we report a case where the patient was initially diagnosed as an isolated case of pyoderma gangrenosum (PG), but investigations revealed urinary tract infection thus proving the association of PG secondary to hidden focus of infection.

   Case Report Top

A 52 - year - old male patient presented with one ulcerated skin lesion which started as a vesiculopustule on left hand, of one month duration and one lesion each, on right hand and right cheek of 15 days duration. The lesions were painless and non- pruritic. There was no history of fever, joint pain, constipation, diarrhoea, malena or burning micturition. History of extramarital contact was absent.
On examination, the lesion, on dorsum of left index finger, was an ulcerated plaque 6 x 3 cm [Figure - 1] with ragged and udermined edge, erythematous and bluish tinged margin and necrotic base. The lesion
on dorsolateral aspect of right hand [Figure - 1] was a noduloplaque 3 x 3 cm with crusting and ulceration, and one on right cheek was a 1 cm folliculo nodular lesion with superficial ulceration.
Laboratory investigations showed Hb-13.5 gm%, normal peripheral blood film, TLC - 8400/mm3, DLC-N-61%, L-33%, E-5%, B-1%, ESR-30 mm/first hr, FBS -105mg%, SGOT - 14 IU/L, and SGPT - 161U/ L. Urine examination showed 9-10 pus cells/HPF;2-4 RBCs, culture examination showed E.coli sensitive to norfloxacin. Consecutive 3 stool tests, and chest X-ray were normal. Mantoux test was negative.
Clinically, diagnosis of pyoderma gangrenosum was made. A wedge biopsy was taken from the bigger lesion. The patient was put on treatment for UTI with norfloxacin 400mg BD for 5 days. Institution of steroid was deferred in view of biopsy report and patient was called for follow up after 5 days.
Meanwhile, histopathological report showed the following:-
The epidermis showed acanthosis, hyperkeratosis and necrosis at places with predominance of degenerated neutrophils. The deeper dermis showed mononuclear cells with lymphocytes and plasma cells. Fibrinoid deposits and thrombi were seen in the vessel wall. The dermal papillae showed numerous extravasated RBCs and small areas of haemorrhage. All the findings were consistent with our diagnosis of PG.
Re-examination of the patient after five days showed dramatic improvement. The lesion on face and right hand had healed with mild scarring whereas the size of lesion on left hand had decreased in size and showed no signs of activity.

   Discussion Top

Pyoderma gangrenosum has been described in association with ulcerative colitis, Crohn's disease, rheumatoid arthritis, monoclonal gammopathies, myeloproliferative diseases, post traumatic infectious diseases, diabetes etc.[3] In 10 - 30% of cases it occurs as an isolated cutaneous phenomenon. In our case PG was clinically diagnosed as an isolated cutaneous phenomenon without any association. Our investigations revealed asymptomatic UTI. The temporal correlation of healing of the lesions with treatment of UTI confirms the association of PG with UTI. The dramatic improvement in short time, as in our case, is unlikely without corticosteroid or treatment of the cause. A careful examination and complete investigation should be done in all cases of PG and if any hidden focus of infection is present, as in our case, a full course of antibiotics should be administered. This will lead to reduction in the number of isolated cases of PG and unnecessary administration of corticosteroids can also be avoided. 

   References Top

1.Perry HO, Winkelmann RK. Bullous pyoderma gangrenosum and leukaemia. Arch Dermatol 1972 ; 106 : 901 - 905.  Back to cited text no. 1    
2.Callen JP. Cutaneous vasculitis : Relationship to systemic disease and therapy. Curr Probl Dermatol 1993 ; 5 : 45.  Back to cited text no. 2    
3.Rook, Wilkinson, Ebling. Pyoderma gangrenosum. Textbook of Dermatology. Vol 3; 6th edition : 2186.  Back to cited text no. 3    


Print this article  Email this article
Previous article Next article


Online since 15th March '04
Published by Wolters Kluwer - Medknow