Wegener's Granulomatosis Presenting as Pyoderma Gangrenosum

Seung Joo Nam; Jin Hyun Woo; Seong Jae Choi; Jong Dae Ji; Gwan Gyu Song; Young Ho Lee

doi:10.4078/jkra.2008.15.2.153

Journal List > J Korean Rheum Assoc > v.15(2) > 1003617

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Nam, Woo, Choi, Ji, Song, and Lee: Wegener's Granulomatosis Presenting as Pyoderma Gangrenosum

Original Article

J Korean Rheum Assoc 2008;15(2):153-158.

Published online: 20 June 2008

DOI: https://doi.org/10.4078/jkra.2008.15.2.153

Wegener's Granulomatosis Presenting as Pyoderma Gangrenosum

Seung Joo Nam, Jin Hyun Woo, Seong Jae Choi, Jong Dae Ji, Gwan Gyu Song, Young Ho Lee

Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea

Received 22 October 2007 Accepted 24 April 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Wegener's granulomatosis is multi-systemic disease characterized by granulomatous necrotizing vasculitis and it usually affects upper and lower respiratory tracts. Cutaneous manifestation as an initial presentation is unusual and comprises about 15% of cases. The most frequent skin lesions are palpable purpura, papules, ulcerations, vesicles, subcutaneous nodules, necrotizing ulcerations. We report a patient with Wegener's granulomatosis who presents as a pyoderma gangrenosum.

Keywords: Wegener granulomatosis, Pyoderma gangrenosum, Skin Manifestations

References

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Fig. 1.

(A) There are hemorrhagic pustules and multiple deep ulcers surrounded by a purple border with mucous discharge on her lower legs. (B) The skin lesion have showed tendency of wax and wane following disease activity. This photograph shows improvement of skin lesion after administration of immunosuppressants.

Fig. 2.

(A) Chest PA shows nodular density in right upper lobe. (B) Chest CT shows round nodule with central air density in right upper lobe.

Fig. 3.

Lung biopsy (×400) shows vasculitis (arrow) with histiocyte aggregation and necrosis.

Fig. 4.

Skin biopsy (×40) shows subcutaneous inflammation (arrow) and magnification of this area (inset, ×200) shows neutrophilic infiltration of subcutaneous tissue.

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