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Images in Intensive Medicine
Pyoderma gangrenosum in a severely burned patient
Pioderma Gangrenoso en paciente gran quemdo
Julio César Matute Mirandaa,
Corresponding author
, Cristóbal Benjamín Valdés Contrerasb
a Unidad de Quemados, Hospital de Urgencia Asistencia Pública, Santiago, Chile
b Unidad de Cuidados Medios, Hospital de Urgencia Asistencia Pública, Santiago, Chile
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    "titulo" => "Pyoderma gangrenosum in a severely burned patient"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A female patient presented with type AB-B burns caused by fire&#44; affecting 41&#46;5&#37; of the body surface&#46; She suffered chronic wounds in the form of ulcerative blister lesions overlying previously traumatized skin&#46; The lesions proved difficult to heal&#44; were very painful&#44; and an underlying infectious or rheumatological origin was discarded&#46; A skin biopsy showed superficial perivascular and interstitial dermatitis with intraepithelial neutrophils and edema&#46; Pyoderma gangrenosum was suspected based on the evolution of the wounds&#44; with the diagnosis being established through exclusion and supported by the histopathological findings with the granulocytic infiltrate&#46; Treatment was continued with deep subcutaneous betamethasone in donor zones&#44; together with 0&#46;05&#37; clobetasol propionate&#44; with reduction of the damaged areas and clinical improvement with healing of the ulcerations&#46; Enteral cyclosporine was subsequently prescribed&#44; continuing with the intralesional corticosteroid infiltrations&#44; with complete clinical healing in 8 weeks&#44; followed by hospital discharge and follow-up on an outpatient basis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure1</a> Figs&#46; 1 and 2&#41;&#46; Skin biopsy with hematoxylin-eosin and Van Gieson staining &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 3</a>&#41;&#58; skin fragment with epidermis presenting discrete compact laminar keratosis&#44; with hypergranulation foci and neutrophils within the horny layer&#46; The papillary dermis presents a chronic lymphoplasmacytic inflammatory infiltrate with an interstitial and perivascular distribution&#46; Isolated groups of granulocytes are also observed at the dermo-epidermal interface and at the superficial perivascular level&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Matute Miranda JC and Vald&#233;s Contreras CB&#46; Pioderma gangrenoso en paciente gran quemado&#44; Med Intensiva&#46; 2023&#46; <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.medin.2023.08.004">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;medin&#46;2023&#46;08&#46;004</span></p>"
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Article information
ISSN: 21735727
Original language: English
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