PMC3937560_01
Skin lesion starting as flaccid bulla resulting in deep purulent ulcer.
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There were some satellite pustules measuring about 1 cm in diameter (Fig. 1).
Chest radiography (A) showing pleural-based nodules which are better visualized on computed tomography with cavity in the right lower lobe (B).
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Chest radiograph showed three subpleural nodules (Fig. 2A), one of them had cavities which were better defined on computed tomography (Fig. 2B).
Sigmoidoscopic examination demonstrating friable deeply ulcerated mucosa in sigmoid and descending colon.
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For clinical suspicion of ulcerative colitis, sigmoidoscopy was performed, which demonstrated endoscopic evidence of ulcerative colitis (Fig. 3).
Colon biopsy showing crypt distortion and increased chronic inflammation within the lamina propria. Arrows denote two small crypt abscesses (inset: small crypt abscess and mixed inflammatory infiltrate within the lamina propria including neutrophils).
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Histopathology of colonic biopsy showed ulceration, focal areas of scarring, mild crypt distortion, mild acute cryptitis, increased chronic inflammation, and small crypt abscesses without granulomas consistent with ulcerative colitis (Fig. 4).
Low power of right anterior proximal thigh skin biopsy showing changes of pyoderma gangrenosum. The center of the lesion (denoted by long blue arrows) shows a dense neutrophilic infiltrate with leukocytoclasia and dermolysis (inset: high power image of inflammatory infiltrate). Short green arrows point to undermining of epidermis by inflammatory infiltrate to the left and cutaneous ulceration to the center and right.
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Punch biopsy from her thigh showed necrotizing suppurative inflammation associated with ulceration and focal secondary perivascular acute inflammation consistent with pyoderma gangrenosum (Fig. 5).