PYODERMA GANGRENOSUM IN DIVERTICULAR DISEASE WITH ACUTE EXACERBATION

Case Presentation An 81-year-old female patient with a dermatological diagnosis of pyoderma gangrenosum presented with a skin lesion on the left pre-tibial region. After excluding inflammatory bowel disease (IBD) and malignancies, she was treated with immunosuppressive therapy (corticosteroids and mycophenolate) with good disease control. Eight months after the onset of the dermatological condition, the patient developed anemia, elevated C-reactive protein, abdominal pain, and rectal bleeding. Abdominal computed tomography showed marked thickening of the sigmoid, descending colon, and upper rectum walls, with a well-organized thick-walled hydroaerial pelvic collection measuring approximately 25.3 cm³. This collection was near the sigmoid colon and demonstrated fistulous tracts originating from the upper rectum and distal sigmoid, converging in the mesorectum. Suspicion of IBD resurfaced, necessitating differential diagnosis with complicated acute diverticulitis. Clinical optimization was performed, including blood transfusion, parenteral nutrition, cessation of immunosuppressants, continuation of low-dose corticosteroids, and consultation with a specialized IBD team. After two weeks, the patient underwent laparoscopic rectosigmoidectomy with protective ileostomy. During surgery, the sigmoid colon was found to be firmly adhered to the pelvis, with a contained abscess that released purulent material upon dissection. Two months post-surgery, the ileostomy was reversed without complications, and the histopathological examination of the resected specimen confirmed a diagnosis of colonic diverticular disease with acute exudative inflammation (diverticulitis), ruling out IBD. The pyoderma lesion completely healed following the second surgery.

Discussion Pyoderma gangrenosum is an autoimmune dermatological condition often associated with other autoimmune disorders and malignancies. The patient’s colonic inflammation, abscess, and fistulas raised concerns about a possible association with IBD. However, the management approach, regardless of etiology, was deemed surgical in this case.

Conclusion This case report highlights the potential role of chronic inflammatory processes (in this instance, colonic diverticular disease) in perpetuating pyoderma gangrenosum. The resolution of diverticulitis led to the complete healing of the dermatological lesion, underscoring the importance of addressing underlying inflammatory conditions in the management of pyoderma gangrenosum.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025