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Pyoderma Gangrenosum — RACP Adult Medicine MCQ

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ModerateRheumatologyPyoderma GangrenosumRACP Adult Medicine

A 40-year-old woman with Crohn disease presents with rapidly enlarging painful ulcers on the lower legs with violaceous undermined borders. Swab cultures are negative. Biopsies show sterile neutrophilic infiltration. What is the most likely type of ulcer?

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Correct answer: A — Pyoderma gangrenosum

Rapidly progressive painful ulcers with violaceous (purple) undermined borders, sterile neutrophilic infiltrate on biopsy, and association with IBD is pyoderma gangrenosum. It is a neutrophilic dermatosis. Importantly, surgical debridement is contraindicated (pathergy — worsening with trauma). Treatment is high-dose corticosteroids ± ciclosporin.

Reference: eTG Dermatology – 2024 – Pyoderma Gangrenosum