Affordable Access

Publisher Website

ULCERATIVE PYODERMA GANGRENOSUM IN MIXED CONNECTIVE TISSUE DISORDER: A RARE ASSOCIATION AND ROLE OF AZATHIOPRINE IN THE MANAGEMENT

Authors
Journal
Indian Journal of Dermatology
0019-5154
Publisher
Medknow Publications
Publication Date
Volume
56
Issue
5
Identifiers
DOI: 10.4103/0019-5154.87172
Keywords
  • Correspondence
Disciplines
  • Medicine

Abstract

Dear Sir, We report the case of a 28-year-old housewife who presented with multiple painful non-healing skin ulcers on the legs. Over the preceding 6 years, she had developed progressive generalized weakness; along with progressive skin thickening, which was associated with Raynaud's phenomenon and bilateral asymmetrical polyarthritis. Progressive thickening and stiffening of skin started with swelling and puffiness of fingers, subsequently involving face and progressing proximally to involve the arm and trunk. She was diagnosed as suffering from systemic sclerosis and was on treatment for the same. Since the last 8 months, she developed ulceration, which began as red, tender papulo-nodular lesion and sloughed out to giving rise to ulcerations. Examination revealed well-circumscribed ulcers (3 on left leg and 1 on right leg) with sharp, tender, irregular, crenated border and purulent granulating necrotic base [Figures 1 and 2], along with pseudo-clubbing and bilateral puffiness of fingers and ulceration at the knuckles and tip of the digits [Figure 3]. At presentation she also gave history of exertional dyspnea, heartburn and dysphagia; however, there was no history of chest pain, dryness of mouth, seizures or fetal loss. Patient was on nonsteroidal anti-inflammatory drugs (NSAIDs) and intermittent steroid therapy; and examination of respiratory, cardiovascular, neurological and reticulo-endothelial systems was unremarkable. Figure 1 Ulceration on the shin showing sharp, irregular, bluish, swollen margin with the floor covered with necrotic and purulent material Figure 2 Multiple ulceration on the dorsa of foot showing bluish irregular margin and covered with unhealthy granulation tissue with swollen toes Figure 3 Pseudo-clubbing and bilateral puffiness of fingers and ulceration at the knuckle Punch biopsy of skin was taken from the edge of the ulcer, and it revea

There are no comments yet on this publication. Be the first to share your thoughts.