Propylthiouracil Induced p-ANCA+ Pyoderma Gangrenosum with Inflammatory Bowel Disease in Pregnancy
DOI:
https://doi.org/10.66344/jpad.v33i4.2362Keywords:
inflammatory bowel disease, pregnancy, propylthiouracil, pyoderma gangrenosum, split-thickness skin graft surgeryAbstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by painful ulcers with undermined edges and peripheral erythema. The global incidence of PG is estimated to be 3 to 10 cases per million people per year, affecting individuals aged between 25 to 54 years. We here present a case report of a 34-year-old female with deep painful non-healing ulcers on both legs which first appeared during her pregnancy. Prolonged consumption of propylthiouracil (PTU) to treat hyperthyroidism was found. Gastrointestinal symptoms were denied. Histopathological examination revealed intense neutrophilic infiltration of the dermis in the skin biopsy and chronic ulcerative inflammation in the biopsy of ileum and colon. The result of p-ANCA was positive. The patient was diagnosed with drug-induced pyoderma gangrenosum associated with PTU use and inflammatory bowel disease. Combination therapy of systemic corticosteroid, two split-thickness skin graft (STSG) surgeries, oral dapsone, appropriate wound care, and management to eliminate predisposing factors resulted in a favorable outcome. Pyoderma gangrenosum has been considered a challenging disease to diagnose and treat. Clinicians need to enhance their knowledge of diagnosis and management of PG to give proper management and yield a better prognosis.
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