PYODERMA GANGRENOSUM COMPLICATING ILEOSTOMY IN A PATIENT WITH ULCERATIVE COLITIS – A CASE REPORT

Case Presentation KLS, female, 35 years old, diagnosed with UC in 2020, colonoscopy revealed pancolitis and ulcers. In addition to diarrhea with blood and mucus, she had arthritis and sacroiliitis. She has an allergy to sulfasalazine and was refractory to corticosteroid treatment, also showing inadequate response to Infliximab, and was thus submitted to subtotal colectomy with cecostomy in October 2020, a decision made by the general surgery team as an emergency. After four months, symptoms returned, with sigmoidoscopy indicating Mayo 3. Therapy with Tofacitinib was attempted without success, followed by Vedolizumab for 14 months, which also proved ineffective, with symptoms and endoscopic worsening. Golimumab and Mesalazine suppository were tried without response, resulting in the need for total proctectomy with cecum resection and creation of a definitive terminal ileostomy in December 2023. In March 2024, she was hospitalized with nodular, purple, ulcerated lesions with raised edges, painful, with purulent secretion drainage in the peristomal region and adjacent skin detachment, diagnosed with pyoderma gangrenosum (PG). She underwent treatment with various antimicrobials and special dressings during prolonged hospitalization, without success. A decision was made for surgery to reposition the ileostomy and debride the ulcerated lesion on the abdominal wall in April 2024. She was discharged after one month of surgery, with the wound improving, continuing follow-up and care at home. Less than a month after discharge, lesions reappeared at the new stoma.

Discussion PG may occur in 1-5% of inflammatory bowel disease cases, not necessarily associated with disease activity. It is defined as a rare inflammatory disorder characterized by chronic, recurrent skin ulcers with necrotic edges. Its etiology and pathogenesis are complex, not well-defined, and multifactorial. There is a wide range of therapeutic options, and combining multiple modalities is more effective than monotherapy, focusing on wound surgical treatment, topical and systemic therapy.

Conclusion PG is an uncommon neutrophilic dermatosis that presents diagnostic and therapeutic challenges. If left untreated, it can significantly impact morbidity and mortality, with an increased risk of developing squamous cell carcinoma in chronic wounds and a threefold increase in mortality among patients with uncontrolled disease.

 

MissingLinkText

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

Publication History

Article published online:
25 April 2025