Blastomycosis-like pyoderma: A diagnostic, as well as, therapeutic challenge
Keywords:Blastomycosis-like pyoderma, pyoderma vegetans
AbstractBlastomycosis-like pyoderma is a very rare, chronic inflammatory disorder, which is also known as pyoderma vegetans (PV). It is commonly seen in middle aged males. It is found to be associated with reduced immunity like primary immunodeficiency syndromes, nutritional deficiencies, HIV infection, diabetes mellitus, chronic myeloid leukemia and alcoholism. It tends to have a link with inflammatory bowel diseases. We report a 41-year-old male who presented with pus filled lesions over his left shoulder, axilla and left elbow for last 4 months. Initially, it was a painless pea-sized lesion, which gradually enlarged to form a larger lesion with central ulceration and peripheral extension. He had consulted a couple of doctors and took multiple courses of antibiotics, which had failed to comfort him of the lesions. Cutaneous examination revealed a well‑defined large plaque, sized 16×14cm over the left shoulder extending to the axilla with few pustules, which had erythematous base with serous-purulent discharge. The plaque was nontender and ulcerated, with uneven surface, elevated edges and yellowish crust. There was a similar smaller (sized 5×3cm) plaque over the left elbow. Colonoscopy was not suggestive of either Crohn’s disease or ulcerative colitis. Histopathological examination revealed pseudoepitheliomatous hyperplasia and upper dermal abscesses with predominantly neutrophilic infiltrate. He was further started on prednisolone 40mg once a day in the morning hours after breakfast along with antibiotic for 10 more days. Corticosteroid was tapered by 10mg every 10 days and 10mg was given for a period of 1 month. Resolution of vegetating granulation tissue was observed within 10 days month and complete remission in 1 month. It is very essential to be familiar with PV, as correct diagnosis may reveal an underlying inflammatory bowel disease.
Adişen E, Tezel F, Gurer MA: Pyoderma vegetans: a case for discussion. Acta Derm Venereol 2009;89:186–8.
Papadopoulos AJ, Schwartz RA, Kapila R, et al: Pyoderma vegetans. J Cutan Med Surg 2001;5:223–7.
Bianchi L, Carrozzo AM, Orlandi A, Campione E, Hagman JH, Chimenti S: Pyoderma vegetans and ulcerative colitis. Br J Dermatol 2001;144:1224–7.
Soriano ML, Martinez N, Grilli R, Farina MC, Martin L, Requena L: Pyodermatitis-pyostomatitis vegetans: report of a case and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:322– 6.
Su WP, Duncan SC, Perry HO. Blastomycosis‑like pyoderma. Arch Dermatol 1979;115:170‑3.
Nigen S, Poulin Y, Rochette L, Levesque MH, Gagne E: Pyodermatitis-pyostomatitis vegetans: two cases and a review of the literature. J Cutan Med Surg 2003;7:250–5.
Leibovitch I, Ooi C, Huilgol SC, Reid C, James CL, Selva D: Pyodermatitis-pyostomatitis vegetans of the eyelids case report and review of the literature. Ophthalmology 2005;112:1809–13.
Brinkmeier T, Frosch PJ: Pyodermatitis-pyostomatitis vegetans: a clinical course of two decades with response to cyclosporine and low-dose prednisolone. Acta Derm Venereol 2001;81:134–6.