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2011, Number 3

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Rev Mex Pediatr 2011; 78 (3)

Complicated varicella with probable pyoderma gangrenosum

Ferreira ÁFE, León MAY, Baños SC

Language: Spanish
References: 25
Page: 108-113
PDF size: 132.22 Kb.


ABSTRACT

The following are five cases of probable pyoderma gangrenosum (PG). These cases are characterized by anemia and the presence of a necrotic ulcer with irregular borders, associated with varicella. The first two cases had a crusting phase which was complicated. The ulcers healed without the need for surgery; however they required hospitalization, isolation, and twice a day wound cleaning using a local rifamycin. There were 3 cases that required surgical treatment. These were: A 4 year-old male, who had a single lesion on the left side of the thorax. A 2 year-old girl with varicella in the crusting phase, which she rapidly got worse. A 7 year old patient with varicella, and whose lesions got worse in a 4 day period. Both patients arrived to the Emergency Department and were admitted to the Intensive Care Unit, previously these patients had an out-patient management that consisted of at least 3 antibiotics without a favorable response; therefore there was a need to use a combined treatment that consisted of surgical debridement of necrotic tissue, wound closure with local skin flaps or skin grafts, along with continuous irrigation with rifamycin. Steroids were not used locally or systemically. There were no signs of neutrophilic infiltrates in the skin.


REFERENCES

  1. Crowson AN, Mihm MC Jr, Magro C. Pypoderma gangrenosum: a review. J Cutan Pathol 2003; 30(2): 97-107.

  2. Charles CA, Leon A, Banta MR, Kirsner RS. Etanercept for the treatment of refractory pyoderma gangrenosum: a brief series. Int J Dermatol 2007; 46(19): 1095-9.

  3. Lyon CC, Smith AJ, Beck MH, Wong GA, Griffiths CE. Parastomal hypoderma gangrenosum: clinical features and management. J Am Acad Dermatol 2000; 42(6): 992-1002.

  4. Passarini B, Infusino SD, Barbieri E, Varotti E, Gionchetti P, Rizzeilo F et al. Cutaneous manifestations in inflammatory bowel diseases: eight cases of psoriasis induced by anti-tumor-necrosis-factor antibody therapy. Dermatology 2007; 215(4): 295-300.

  5. Callen JP. Pyoderma gangrenosum: Diagnosis, etiology and therapy. Lancet 1998; 351: 581-5.

  6. Regueiro M, Valentine J, Pleuys, Fleisher MR, Lichtenstein GR. Infliximab for treatment of Pyoderma gangrenosum associated with inflammatory Bowel disease. Am J Gastroenterol 2003; 98(8): 1821-6.

  7. Wittekindt C, Lüers JC, Klussmann JP, Hüttenbrink KB. Pyoderma gangrenosum in the head and neck. Arch Otolariyngol Head Neck Surg 2007; 133(1): 83-5.

  8. Ridenhour G, Stephenson HEJr. Pyoderma gangrenosum successfully treated with aqueous silver nitrate (0.5 per cent) steroids and skin autografts. Ann Surg 1968; 168(5): 905-10.

  9. Chow RK, Ho VC. Treatment of pyoderma gangrenosum. J Am Acad Dermatol 1996; 34(6): 1047-60.

  10. Cummins DL, Anhalt GJ, Monahan T, Meyerle JH. Treatment of pyoderma gangrenosum with intravenous immunoglobulin. Br J Dermatol 2007; 157(6): 1235-9.

  11. Panuncialman J, Falanga V. Basic approach to inflammatory ulcers. Dermatol Ther 2006; 19(6): 365-76.

  12. D’Incá R, Fagluoli S, Sturniolo GC. Tacrolimus to treat pyoderma gangrenosum resistant to cyclosporine. Ann Intern Med 1998; 128(9): 783-4.

  13. Meyer N, Ferraro V, Mignard MH, Adamski H, Cheurant B. Pyoderma gangrenosum treated with high-dose intravenous immunoglobulins: Two cases and review of the literature. Clin Drug Investing 2006; 26(9): 541-6.

  14. Tallon B, Rademaker M, Parkinson G, Whitley B, Swarbrick M. Cavitary pyoderma gangrenosum treated with local infusion of corticosteroid. J Am Acad Dermatol 2007; 56(4): 695-9.

  15. Davis JC, Landeen JM, Levine RA, Pyoderma gangrenosum: skin grafting after preparation with hyperbaric oxygen. Plast Reconstr Surg 1987; 79(2): 200-7.

  16. Valesky EM, Spieth K, Beier C, Wolter M, Kaufmann R. Postoperative pyoderma gangrenosum of Cullen. Unfallchirurg 2007; 110(11): 973-6.

  17. Wollina U. Clinical management of pyoderma gangrenosum. Am J Clin Dermatol 2002; 3(3): 149-58.

  18. Mehta AJ, Woodrow S, St John A. Pyoderma gangrenosum on varicella lesions. Clin Exp Dermatol 2007; 32(2): 215-7.

  19. Eichhorn JP, Peeters R, Werner J, Bartop, Lambert J, Beaucourt L, Poucke SV. Pyoderma gangrenosum. Dermatologic Therapy 2001; 14(1): 102–10.

  20. Alam M, Grossman ME, Schneiderman PI, Blume RS, Benvenisty AI. Surgical management of pyoderma gangrenosum: case report and review. Dermatol Surg 2000; 26(11): 1063-6.

  21. Cliff S, Holden CA, Thomas PR, Marsden RA, Harland CC. Split skin grafts in the treatment of pyoderma gangrenosum. Dermatol Surg 1999; 25: 299-302.

  22. Wollina U. Pyoderma gangrenosum-a review. Orphanet J Rare Dis 2007; 15:2-19.

  23. Sub WP, Davis MD, Weenig RH, Powell FC, Perry HO. Pyoderma gangrenosum: clinicopathologic correlation and proposed diagnostic criteria. Int J Dermatol 2004; 43(11): 790–800.

  24. Dinulos JG, Darmstadt GL, Len MK, Rultledge JC, Murray KF. Infantile Crohn disease presenting with diarrhea and pyoderma gangrenosum. Pediatr Dermatol 2006; 23(1): 43-8.

  25. Brooklyn T, Dunnill G, Probert C. Diagnosis and treatment of pyoderma gangrenosum. BMJ 2006; 333(7560): 181-4.




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