Peristomal pyoderma gangrenosum

Abstract

Pyoderma gangrenosum (PG) is an idiopathic ulcerative skin disease that may be the cutaneous manifestation of many systemic diseases. Although the ulcers usually appear on the lower extremities, we report a case of peristomal pyoderma gangrenosum in a 25-year-old white female after proctocolectomy and ileostomy for ulcerative colitis. A total of 17 other cases of peristomal PG have been reported to date. In addition to the site of the ulcers, the case is remarkable because the patient was refractory to multiple trials of systemic therapy, including cyclosporine, until issues of local wound care were addressed. Effective local treatment was achieved using a calcium alginate dressing overlying pulverized sucralfate applied to the ulcers as well as enlarging the size of the ostomy bag opening. These local measures combined with systemic cyclosprine and prednisone led to complete ulcer healing in 9 weeks.