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\begin{document}

\title{Ulcerative Wound in a Patient with Ulcerative Colitis}



\author[1]{Delvise Fogwe}%
\author[2]{Raya Abu Tawileh}%
\author[1]{Shah Aditya}%
\affil[1]{Mayo Clinic Rochester}%
\affil[2]{The University of Jordan School of Medicine}%


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  \date{March 13, 2025}


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\textbf{Ulcerative Leg Wound in a Patient with Ulcerative Colitis}

\textbf{Question:} A 43-year-old male with a history of ulcerative
colitis status post subtotal colectomy with end ileostomy presents with
fevers and worsening right shin ulcerative wound. He had minor trauma to
his right shin leading to erythema, tenderness, and ulceration (Figure 1
A, B, \& C). He received two courses of oral antibiotics for presumed
cellulitis yet had rapid wound progression. Biopsy from the wound showed
dense dermal neutrophilic infiltrate and no growth in bacterial or
fungal cultures (Figure 1 D\& E). HIV, Hepatitis B, and C serology,
antinuclear antibodies, and anti-cytoplasmic antibodies were all
negative. What is the most likely diagnosis?

\textbf{Answer:} This is a classic case of ulcerative pyoderma
gangrenosum (PG). PG is a rare neutrophilic dermatosis secondary to an
aberrant inflammatory process that presents with rapidly progressing
painful purulent ulcers, usually after a minor
trauma\textsuperscript{1}. PG is often confused with soft tissue
infection leading to delayed diagnosis. However, associated conditions
such as inflammatory bowel disease and inflammatory arthritis should
raise suspicion for PG\textsuperscript{1}. A biopsy is needed for
diagnosis after ruling out infection since the treatment is with
immunosuppressive therapy\textsuperscript{2}. Debridement should be
avoided since it may worsen symptoms in the phenomenon known as the
pathergy effect\textsuperscript{2}.

\textbf{Reference}

Maverakis, E., Marzano, A.V., Le, S.T.~\emph{et al.} ~Pyoderma
gangrenosum.~\emph{Nat Rev Dis Primers} ~\textbf{6,~} 81 (2020).
https://doi.org/10.1038/s41572-020-0213-x

Goldust M, Hagstrom EL, Rathod D, Ortega-Loayza AG. Diagnosis and novel
clinical treatment strategies for pyoderma gangrenosum. Expert Rev Clin
Pharmacol. 2020 Feb;13(2):157-161. doi: 10.1080/17512433.2020.1709825.
Epub 2020 Jan 6. PMID: 31875484.\selectlanguage{english}
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