Ann Dermatol.  2018 Feb;30(1):79-82. 10.5021/ad.2018.30.1.79.

Paraneoplastic Pyoderma Gangrenosum Associated with Rectal Adenocarcinoma

• You HR
• Ju JK
• Yun SJ
• Lee JB
• Kim SJ
• Won YH
• Lee SC

• KMID: 2399759
• DOI: http://doi.org/10.5021/ad.2018.30.1.79

Abstract

Pyoderma gangrenosum (PG) is a rare chronic neutrophilic dermatosis characterized by painful necrotic ulceration. The most common diseases associated with PG are inflammatory bowel disease, certain rheumatologic and hematologic diseases, and malignancy. Here, we describe the case of a 60-year-old man who presented with pruritic and painful erythematous ulcerative macules and patches on both lower extremities, and was diagnosed with PG based on his clinical and histologic features. His PG became exacerbated despite standard therapy with a high-dose systemic steroid in combination with dapsone and cyclosporine. Systemic evaluation of underlying conditions revealed rectal adenocarcinoma at the rectosigmoid junction (T3N0M0), which was completely removed via Hartmann's procedure followed by adjuvant chemotherapy. Two months after anticancer therapy, his PG was completely healed with hypertrophic scarring. Herein, we present the first case of paraneoplastic PG caused by rectal adenocarcinoma in Korea.

Keyword

Colonic neoplasms; Paraneoplastic; Pyoderma gangrenosum

MeSH Terms

Adenocarcinoma*
Chemotherapy, Adjuvant
Cicatrix, Hypertrophic
Colonic Neoplasms
Cyclosporine
Dapsone
Hematologic Diseases
Humans
Inflammatory Bowel Diseases
Korea
Lower Extremity
Middle Aged
Neutrophils
Pyoderma Gangrenosum*
Pyoderma*
Skin Diseases
Ulcer
Cyclosporine
Dapsone

Figure

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  Fig. 1 Clinical photograph, showing ulcerative patches on bilateral lower extremities with edema.

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  Fig. 2 (A) Colonoscopic image, showing an ulcerofungating mass at the rectosigmoid junction. (B) Hartmann's procedure was performed for resection of colon cancer. A 5.5×4-cm rectal adenocarcinoma (T3N0M0) was found. (C) Clinical photograph, showing completely healed pyoderma gangrenosum lesions with hypertrophic scarring after the fourth rounds of adjuvant chemotherapy.

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