PMC6482159_01
Dermatological and histopathological characteristics of pyoderma gangrenosum. (a,b) Ulcerative lesions showing necrotic base and erythematous-violaceous undermined borders on the right and left breast, respectively; (c) Skin histology revealing epidermal necrosis and a dermal-hypodermal inflammatory infiltrate mainly consisting of neutrophils (haematoxylin-eosin, original magnification x 100) (in the box, a magnified detail of the inflammatory infiltrate); (d,e) Partial healing after therapy with pulsed intravenous methylprednisolone, followed by the combination of prednisone and cyclosporine given orally; (f,g) Complete healing with hypertrophic aspects.
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F1
A 51-year-old woman was hospitalized for the occurrence of two bilateral painful skin ulcers with undermined, erythematous-violaceous edges in the mammary region, which had begun 6 months before and had rapidly developed from pustular lesions (Figures 1a,b). Skin biopsy showed a dermal-hypodermal neutrophilic infiltrate, suggesting PG (Figure 1c). Pulse-therapy with intravenous methylprednisolone 125 mg daily for 5 consecutive days was given with clinical improvement, followed and followed by prednisone at progressively tapering dosages in combination with cyclosporine 300 mg daily, inducing progressive healing of the lesions (Figures 1d-g).
Neck ultrasonography performed at 12-month follow-up visit after thyroidectomy. (a) Transversal scan shows two adjacent left paratracheal lesions (arrows). These marked hypoechoic areas have ill-defined margins but not microcalcifications; (b) Longitudinal scan depicts the elongated shape of the paratracheal lesion (lateral one) and its parallel orientation to the dermis without deformation of surrounding tissues, unlike true focal masses.
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F2
However, US examination of the neck performed 12 months after thyroid surgery revealed two hard hypoechoic avascular areas with irregular margins in the thyroid bed, which measured 16 mm and 15 mm in their maximum diameter, respectively (Figure 2).
Neck ultrasonography performed at 10-month follow-up visit after the second cycle of intravenous methylprednisolone treatment shows complete regression of the two hypoechoic areas in the thyroid bed.
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F3
Both lesions mentioned above were no more visible after 10 months (Figure 3) confirming thyroid bed involvement by PG.