pyostomatitis  pyodermatitis vegetans ( ppv ) is a rare inflammatory disorder of the mucous membranes and skin , which is usually accepted as a marker of inflammatory bowel diseases ( ibds ) , especially ulcerative colitis . although this entity is commonly seen with ibds , it was also reported with sclerosing cholangitis , chronic hepatitis , and pericolangitis in the literature . mucosal lesions are known as  pyostomatitis vegetans  and characterized by edematous mucosa , multiple white - yellow pustules , vegetating hemorrhagic erosions , and ulcerations . cutaneous lesions are known as pyodermatitis vegetans and characterized by white - yellow pustules , crusted papules , and plaques that coalesce into annular lesions and resemble histopathological examination and immunflorescence ( which is typically negative ) and history of ibd are helpful in confirming the diagnosis . mucosal and cutaneous lesions usually show the same histological features including intraepidermal and superficial dermal microabscesses containing neutrophils and eosinophil polymorphs and mixed deeper dermal inflammatory infiltrate . systemic dapsone , azathioprine , cyclosporine , isotretinoin , infliximab , etanercept , methotrexate , and subtotal / total colectomy are other treatment options . we present a young male with thickly crusted erosions on sternum , shoulders , back , and lower extremities , which appeared after total colectomy surgery for ulcerative colitis . a 16-year - old male patient presented to our outpatient clinic with a 4 months history of thickly crusted erosions on his scalp , sternum , right shoulder , back , and bilateral lower extremity [ figure 1 ] . he had ulcerative colitis since 4 years and was treated with systemic corticoteroids for 2 years . total colectomy was performed 7 months ago and systemic corticosteroid therapy was discontinued after colectomy . hemorrhagic crusted erosions on sternum , right shoulder , back , and right leg two punch biopsy specimens and a direct immunflorescence specimen were taken from the margins of erosions on his right shoulder and sternum with initial diagnosis of pemphigus vegetans , pyodermatitis vegetans , acne conglobata , and pyoderma gangrenosum . histopathological examination of the biopsy from the right shoulder revealed nuclear debris , crusts , and irregular acanthosis in the epidermis , and dense capillary proliferation , plasma cells , eosinophils , and lymphocytic infiltrate in the dermis [ figure 2 ] . hyperkeratosis , acanthosis , exocytosis in epidermis , edema , and dense lymphocytic infiltrate were seen in dermis in the specimen that was taken from sternum . he was diagnosed as pyodermatitis vegetans based on his history , clinical findings , and histopathological examination . his lesions almost totally regressed within 1 month with systemic methylprednisolone 40 mg / d and topical mupirocin [ figure 3 ] . crusts , irregular acanthosis in epidermis , dense capillary proliferation , and plasma cells , eosinophils and lymphocytic infiltrate in the dermis ( h and e 40 ) almost complete reepithelization within 1 month with systemic methylprednisolone 40 mg / d pyostomatitis  pyodermatitis vegetans ( ppv ) is a rare and well - known inflammatory dermatosis , which is usually associated with ibd . it was first described in 1898 by hallopeau in five patients who had oral pustular and cutaneous vegetating lesions . association of the pustular lesions with ibd was described by mccarthy et al . in 1949 . ppv is seen in adults after the third decade and more common among males ( m : f = 3:1 ) . our patient was a 16-year - old male , the youngest patient reported with this diagnosis . erythematous , vesiculopustular , exudative , annular , vegetating plaques are the common cutaneous manifestations of ppv . reported a case report of ppv and ulcerative colitis in whom presentation was confused with acneiform lesions . although intertriginous surfaces are most commonly affected regions , extraordinary localizations have been reported in the literature . reported a patient with pyoderma vegetans on the fingers of the left hand and the foot . yasuda et al . reported a patient with erythematous , crusted , erosive and vegetating lesions of ppv on the mandible and lower lip that responded well to total colectomy and topical tacrolimus . reported a case report of pyodermatitis  pyostomatitis vegetans of the eyelid that completely healed with systemic steroids and sulfasalazine . in our patient , lesions were located on shoulders , sternum , lower extremity and appeared 3 months after the total colectomy operation . systemic corticosteroids , dapsone , sulfasalazine , azathioprine , cyclosporine , and subtotal / total colectomy , and topical tacrolimus are most preferred treatment options of ppv . although subtotal / total colectomy has been reported as a treatment option for ppv in the literature , lesions appeared after total colectomy surgery in our patient that responsed very well to systemic methylprednisolone within one month . kitayama et al . reported a case similar to our patient who had ppv that appeared after subtotal colectomy . our case led us to consider that ppv could be a marker of continuing systemic inflammation . the case is being reported for its rarity , young age of the patient , unusual localization of lesions and their occurence after total colectomy surgery .
pyostomatitis  pyodermatitis vegetans ( ppv ) is a rare dermatological manifestation of inflammatory bowel disease , characterized by erythematous , vesiculopustular , exudative , annular , and/or vegetating plaques over the intertriginous regions that may precede or appear at the same time as the mucosal lesions . 
 systemic corticosteroids , dapsone , sulfasalazine , azathioprine , cyclosporine , and subtotal / total colectomy are the most common treatment options . 
 a 16-year - old male patient presented to our outpatient clinic with a four months history of thickly crusted erosions on his trunk , back , and lower extremity . 
 he had ulcerative colitis for four years and total colectomy was done seven months ago . 
 clinical and histopathological examination of his lesions were consistent with pyostomatitis vegetans . 
 although subtotal / total colectomy has been reported as a treatment option for ppv , lesions reappeared three months after total colectomy in our patient .