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Rare disease
CASE REPORT
When a wound is the harbinger of a serious underlying systemic illness
  1. Shweta Kishore1,
  2. Varun Mittal2,
  3. Shradha Ahuja2,
  4. Vikas Majithia1
  1. 1Department of Rheumatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
  2. 2Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
  1. Correspondence to Dr Shweta Kishore, skishore{at}umc.edu

Summary

A 55-year-old woman presented with progressive enlarging and painful non-healing ulcers on her bilateral lower extremities; biopsy was consistent with pyoderma gangrenosum. Workup for an underlying illness revealed a cavitary lung nodule and an ulcerating mass in the anal canal. Patient did not have any respiratory or gastrointestinal symptoms. Differential diagnosis included inflammatory bowel disease, rectal carcinoma or infection such as tuberculosis, fungal process. Histopathology did not reveal any malignancy, inflammatory bowel disease or infection. Serological studies were positive for perinuclear antineutrophil antibodies specific to proteinase-3 antigen, and the patient was ultimately diagnosed with granulomatosis with polyangiitis. Intravenous pulse dose steroids were initiated followed by monthly pulse cyclophosphamide for 6 months, resulting in rapid and significant improvement of the wounds.

  • vasculitis
  • medical management
  • dermatology
  • immunology

https://doi.org/10.1136/bcr-2017-222491

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    Footnotes

    • Contributors SK: contributed in establishing the diagnosis and management of the patient as a rheumatology consultant, extensive literature search of similar cases, initial preparation of the entire manuscript and compilation of contributions from other authors and obtaining consent from the patient; reviewed the requirements and guidelines for submission and designed the template accordingly. VMi: contributed in literature search and similar cases, found additional cases on Medline, citation management, editing of images, revision of the manuscript twice. SA: patient admitted under SA service, first suspected autoimmune disease, appropriate consultation, helped in facilitating management, prepared the abstract for the manuscript, set up the title for the manuscript, revision of the manuscript and helped in reducing grammatical errors. VMa: served as the chief of the division and supervised all the authors, set up timeline for submission, planning the submission to BMJ, reviewed the requirements, critical revision of the article at every stage, drafted the take-home messages, gave final approval of the version to be submitted. All authors agreed to be accountable for the work and have confidence in the integrity and accuracy of the work.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.