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| CASE REPORT | | | Year : 2006 | Volume : 51 | Issue : 2 | Page : 123-124 | | | Pyoderma gangrenosum and anticardiolipin antibody | | | Jose Maria Pereira de Godoy, Fernando Batigalia, Domingo Marcolino Braile
Department of Cardiology and Vascular Surgery, Sao Jose do Rio Preto University School of Medicine, Sao Paulo, Brazil
Correspondence Address:
Jose Maria Pereira de Godoy
Rua Floriano Peixoto, 2950, Sao Jose do Rio Preto, SP-Brazil CEP: 15010-020
Brazil
DOI: 10.4103/0019-5154.26951 | |  Abstract | | | Pyoderma gangrenosum (PG) is a rare ulceronecrotic inflammatory cutaneous disorder and is frequently associated with systemic diseases. The authors report a 22-year-old male patient with pyoderma gangrenosum, thrombosis of both popliteal arteries, ischemic stroke and seropositivity for anticardiolipin antibody. Despite intravenous treatment with antibiotics, corticosteroid and heparin, pyoderma gangrenosum caused necrosis of his right lower limb which resulted in amputation. It was concluded that the anticardiolipin antibody may have contributed to the gravity of this case.
Keywords: Pyoderma gangrenosum, Anticardiolipin antibody, Thrombosis
How to cite this article:
de Godoy JP, Batigalia F, Braile DM. Pyoderma gangrenosum and anticardiolipin antibody. Indian J Dermatol 2006;51:123-4 |
| Introduction | |  |
Pyoderma gangrenosum was named because it was believed" that streptococcal infection might represent an important factor in its pathogenesis.[1]
The etiology of pyoderma gangrenosum is unknown. However, several clinical disorders have been correlated with this condition.[1] Pyoderma gangrenosum affects commonly 25 to 54-year-old males; its most usual clinical form is ulcerative, mainly attacking the trunk and the inferior extremities.[2] No definitive treatment exists for this disease.
The anticadiolipin antibodies constitute a heterogeneous group of circulating autoantibodies against anionic phospholipids associated with arterial or venous prothrombotic state, recurrent pregnancy loss and thrombocytopenia (antiphospholipid syndrome).[3] The link between pyoderma gangrenosum and anticardiolipin antibodies has been poorly related in medical literature.[4],[5],[6] The objective of this study is to present this correlation and discuss the difficulties in diagnosis and therapy of pyoderma gangrenosum.
| Case Report | | |
A 22-year-old man presented with 1-2 cm non-healing ulcerations with enlarged margins alternating with cicatricial areas and drain simuses.
Two days later, there was the appearance of mental confusion, edema of lower limbs, peripheral cyanosis and marked reduction in distal arterial pulses. Computed tomography of the skull revealed an ischemic area, and lower limb arteriography showed thrombosis of both politeal arteries. Echocardiography showed no changes. Laboratory studies demonstrated leucocytosis (30,6 Gpt/1) and marked increase in erythrocyte sedimentation rate (ESR) and mucoprotein. Serum creatinine, urea, antinuclear antibody (ANA), anti-DNA, C3 and C4 components of complement, antineutrophil cytoplasmic antibody (ANCA), O-antistreptolysin, protein electrophoresis and glycemia were normal.
Circulating anticardiolipin antibodies test was positive for IgG anticardiolipin. Histopathological analysis of lesions was performed and in bacteriological culture growth of Staphylococcus aureus  was reported. Systemic management with clindamycin, amicacin, heparin, corticosteroid, vasodilator (bencyclan) and analgesic was initiated with poor improvement. The patient had no neurological sequelae, but amputation of his right leg was necessary.
| Discussion | | |
The diagnosis of pyoderma gangrenosum is a difficult one to make because of the condition's ability to mimic other ulcerative skin lesions and its lack of specific laboratory and pathologic findings. In this case, the high index of clinical suspicion for pyoderma gangrenosum, the simultaneous thrombosis of lower limbs and cerebrum, and the seropositivity for IgG anticardiolipin antibody suggested the diagnosis. The origin of thrombosis may have been secondary to probable vasculitis or antiphospholipid syndrome. In medical papers, there are few reports concerning the correlation between anticardiolipin antibodies and pyoderma gangrenosum.[4],[5],[6] In one of them, a 28-year-old man presented extensive thrombosis of inferior vena cava.[6] In another one, a 64-year-old woman died as a result of sepsis despite an aggressive therapy with corticosteroids and cyclosporine.[4] In our patient serious arterial thrombotic state culminated in amputation. This is the first report of such a severe outcome correlating pyoderma gangrenosum and seropositivity for anticardiolipin antibody. This clinical case adds further evidence to the possible link between these disorders and warrants a search for anticardiolipin antibodies in patients with pyoderma gangrenosum.
| Conslusion | | |
It is concluded that physical exmaination of pyoderma gangrenosum-like skin lesions provided significant further information. The search for anticardiolipin antibodies must be taken up at the time of any thrombotic events. We suggest that clinicians assay for anticardiolipin antibodies when a clincial diagnosis of pyoderma gangrenosum is entertained.
| References | | |
| 1. | Powell FC, Su WP, Perry HO. Pyoderma gangrenosum: Classification and management. J Am Acad Dermatol 1996;34:395-409.  [PUBMED] | | 2. | Powell FC, Schroeter AL, Su WP, Perry HO. Pyoderma gangrenosum: A review of 86 patients. Q J Med 1985;55:176-86. [PUBMED] | | 3. | Bick RL, Baker WF. O antifosfolipidio e as sindromes tromboticas. In : Disturbios Comuns da Hemostasia. Clin Med Da America do Norte 1994. p. 685-702. | | 4. | Schmid MH, Hary C, Marstaller B, Konz B, Wendtner CM. Pyoderma gangrenosum with the secundary antiphospholipid syndrome. Eur J Dermatol 1998;8:45-7. [PUBMED] [FULLTEXT] | | 5. | Schlesinger IH, Farber GA. Cutaneous ulceration resembling pyoderma gangrenosum in the primary antiphospholipid syndrome: A report of two additional case and review of the literature. J State Med Soc 1995;147:357-61. [PUBMED] | | 6. | Chacek S, MacGregor-Gooch J, Halabe-Cherem J, Nellen-Hummel H, Quinones-Galvan A. Pyoderma gangrenosum and extensive caval thrombosis associated with the antiphospholipid syndrome - A case report. Angiology 1998;49:157-60. [PUBMED] |
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