SHM Converge Scientific Abstract ePoster Gallery-A Wolf in Cellulitis Clothing: Pyoderma Gangrenosum in Ulcerative Colitis

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This case report describes pyoderma gangrenosum (PG), a rare neutrophilic skin disorder that can complicate ulcerative colitis (UC) and often mimics cellulitis or other skin infections. PG most commonly affects the lower extremities and may present early without classic ulcerative or necrotic features, making diagnosis difficult. Clues include pain out of proportion to exam, lack of response to antibiotics, negative infectious testing, and an associated UC flare. In some cases, deeper tissue involvement such as myositis can occur, so imaging may be needed to exclude necrotizing infection or osteomyelitis.<br /><br />A 38-year-old man with long-standing, previously well-controlled UC and rheumatoid arthritis presented with severe bloody diarrhea, abdominal cramping, and several weeks of worsening left leg swelling, erythema, purulent drainage, and extreme pain. He was febrile, tachycardic, and had elevated inflammatory markers, leukocytosis, anemia, and markedly elevated fecal calprotectin. Despite broad-spectrum antibiotics for presumed severe skin and soft tissue infection, he improved minimally. MRI showed skin thickening, subcutaneous edema, and myositis without abscess or bone involvement. Skin biopsy revealed a neutrophilic infiltrate with suppuration and no organisms. Flexible sigmoidoscopy demonstrated severe active UC (Mayo 3).<br /><br />High-dose intravenous corticosteroids were started for the UC flare, leading to rapid improvement in gastrointestinal symptoms, leg pain, and the wound appearance. The report emphasizes that PG can develop even decades after UC diagnosis and that delayed recognition may lead to scarring, superinfection, or limb loss. Early treatment with immunosuppression, particularly corticosteroids or cyclosporine, and control of the underlying IBD flare are essential; anti-TNF therapy may also be effective.

Asset Subtitle

Ali Farkhondehpour

Meta Tag

Author List Ali Farkhondehpour, Beemnet Amdemicael, Julia Weston, Terry Lou

Category Clinical Vignettes

Concept Pyoderma Gangrenosum

Concept Ulcerative Colitis

Concept Systemic Corticosteroid

Concept Neutrophilic Dermatosis

Concept Necrotizing Infection

Distinguished Non-Finalist

Presenter Organization University of California San Diego

Presenting Author Ali Farkhondehpour

Track Adult

Keywords

pyoderma gangrenosum

ulcerative colitis

neutrophilic dermatosis

cellulitis mimic

skin and soft tissue infection

lower extremity ulcer

myositis

skin biopsy

corticosteroid therapy

inflammatory bowel disease flare

Pyoderma Gangrenosum

Ulcerative Colitis

Systemic Corticosteroid

Neutrophilic Dermatosis

Necrotizing Infection