PMC5294749_01
Acute pyoderma gangrenosum on the lower leg.
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His medical history included recurrent PG on the lower extremities, generalized severe acne, and leukocytoclastic vasculitis (LCV) that developed while on 100 mg daily prednisone for a large PG lesion (Fig 1).
Generalized acne on the back.
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Physical examination revealed cysts, papules, and pustules with hyperpigmentation and scarring on the back and chest (Fig 2).
Scarring on the lower back from hidradenitis suppurativa.
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Multiple inflammatory abscesses with sinus tracts and scarring were present on the lower back and buttocks (Fig 3).
Pyoderma gangrenosum ulcer stage.
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A 14-cm ulcer with violaceous, undermined borders was present on the lower leg (Fig 4).
Petechiae on right lower extremity.
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Scattered petechiae with surrounding palpable purpura and hemorrhagic patches developed extensively on the lower extremities (Fig 5, Fig 6, Fig 7).
Hemorrhagic papules and plaques on left lower extremity.
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Scattered petechiae with surrounding palpable purpura and hemorrhagic patches developed extensively on the lower extremities (Fig 5, Fig 6, Fig 7).
Resolving palpable purpura on left lower extremity.
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Scattered petechiae with surrounding palpable purpura and hemorrhagic patches developed extensively on the lower extremities (Fig 5, Fig 6, Fig 7).
Perivascular and interstitial infiltrate of neutrophils with leukocytoclasis, extravasation of red blood cells, and focal fibrin deposition within small vessel walls. (Hematoxylin-eosin stain; original magnification: x10.)
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A skin biopsy was taken of the palpable purpura on the left lateral thigh; histochemical staining revealed a perivascular, interstitial infiltrate composed of neutrophils, demonstrating prominent leukocytoclasis, extravasation of red blood cells, and focal fibrin deposition within small vessel walls (Fig 8).
Ruptured follicle containing a dense neutrophilic infiltrate extending into the surrounding dermis with a patchy perivascular lymphocytic infiltrate. (Hematoxylin-eosin stain; original magnification: x20.)
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A skin biopsy of the lower back was taken, which revealed a ruptured follicle containing a dense neutrophilic infiltrate extending into the surrounding dermis with a patchy perivascular lymphocytic infiltrate (Fig 9).