Bullous pyoderma gangrenosum in patients with ulcerative colitis and multiple myeloma
Nasza Dermatologia Online
Letter to the Editor Sir, Bullous pyoderma gangrenosum (PG) is a rare subtype of PG, which frequently involves extremities. We herein report two cases of bullous PG in association with other systemic diseases, such as hematological malignancy and inflammatory bowel disease. Case 1 A 52-year-old man suffered from stomachache, diarrhea, and bloody stools for some months, and was diagnosed with ulcerative colitis (UC) by colonoscopy examination. Biopsy specimens showed inflammatory cell
... ory cell infiltration in the mucosal epithelium. Almost simultaneously, he developed bullous lesions on the lower legs. Physical examination showed rounded, edematous bloody bullous lesions on the bilateral shin ( Fig. 1) . Laboratory examination showed increased levels of C-reactive protein (CRP; 3.12 mg/dl) and erythrocyte sedimentation rate (53 mm/h), and white blood cell counts (8900/mm3) with 70% neutrophils. Histological examination showed subepidermal bulla and neutrophil and mononuclear cell infiltration in the mid-to lower dermis. After admission, systemic prednisolone (30 mg/day) was administered for intestinal lesions, which also improved skin lesions. Case 2 A 76-year-old man was suffering from multiple myeloma for 8 years. He had been treated with chemotherapies (ranimustine, vincristine, melphalan, dexamethasone), which however could not lead to remission induction. During the course, he was hospitalized and consulted to dermatology department, as for the skin lesions on his forearm. Physical examination revealed hemorrhagic bullae on the left forearm (Fig. 2) . Laboratory examination showed increased levels of CRP (14.7 mg/dl). A biopsy specimen revealed prominent red blood cells, diffuse neutrophil infiltration in the entire dermis (Fig. 3 ). There were no atypical cells. He was initially treated with antibiotics without effects, but successfully treated with oral prednisolone (30 mg/day). Figure 3. Skin biopsy specimen showing numerous neutrophils infiltration with a number of erythrocytes in the dermis. Figure 2. Bullous hemorrhagic lesions on the forearm of Case 2.