Pyoderma gangrenosum and necrotizing arteritis in elderly onset rheumatoid arthritis – a case study


Authors: Hrnčíř Zb 1;  L. Sobotka 2;  M. Pospíšil 2;  P. Prášil 3;  J. Brtková 4;  J. Laco 5
Authors‘ workplace: II. interní gastroenterologická klinika, 2III. interní gerontometabolická klinika, 3Klinika infekčních nemocí, 4Radiologická klinika, 5Fingerlandův ústav patologie, Lékařská fakulta Univerzity Karlovy a Fakultní nemocnice, Hradec Králové 1
Published in: Čes. Revmatol., 26, 2018, No. 2, p. 59-63.

Overview

Pyoderma gangrenosum (PG) is a rare disorder from the group of neutrophilic dermatoses, partly as a serious comorbidity in rheumatoid arthritis. The main form of its clinical manifestation is abacterial necrotizing skin ulceration (-s) with irregular, indurative and violaceous border (espec. trunk/LE). The present study demonstrates a serious form of PG in a 73y old man; the last form of PG composite diagnostic criteria (2017) was completely fulfilled, and the observation was also associated with the following important aspects: (a) clinical manifestation of PG and elderly onset (ACPA and RFs isotypes seropositive) rheumatoid arthritis (EORA) were parallel, (b) PG ulceration was present as a masquerading phenomenon of fibrinoid-necrotic (rheumatoid) arteritis, and (c) the response to long-term glucocorticoid-cyclosporine combination was slow, but up to the presence persistent. Observation of the triade „pyoderma gangrenosum – rheumatoid arthritis – necrotizing arteritis“ may be consider as an inspirative combination both in complicated pathways, and also as an important clinical problem.

Key words:

Elderly onset rheumatoid arthritis, pyoderma gangrenosum, pathergic reaction, necrotizing arteritis, glucocorticoids, cyclosporine


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Labels
Dermatology & STDs Paediatric rheumatology Rheumatology
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