A Case of Pustular Pyoderma Gangrenosum Misdiagnosed as Acute Febrile Neutrophilic Dermatosis in a Pediatric Patient

Abstract

Background

Pyoderma gangrenosum (PG) is a rare cause of skin ulcers in children, posing challenges in diagnosis and treatment. As the disease is often associated with conditions such as inflammatory bowel disease (IBD), rheumatoid arthritis, haematological disorders and other diseases, diagnosis and treatment often require cooperation with other medical departments. Accordingly, dissemination of information about the disease to doctors in departments other than dermatologists, especially paediatricians, can help in its early detection.

Case Presentation

The 11-year-old pediatric patient in the case initially diagnosed with acute febrile neutrophilic dermatosis was eventually confirmed as pustular PG through histopathological examinations of skin and other relevant examinations. The medical condition is lessened after treatment with a combination of glucocorticoids and adalimumab.

Conclusion

PG is relatively rare in clinical settings, particularly among pediatric patients exhibiting persistent high fever and signs of pustular pyoderma gangrenosum. This case underscores the importance of considering the potential diagnosis of pediatric pustular PG when confronted with a child presenting persistent high fever and pustules after trauma. Additionally, the proactive initiation of adalimumab emerges as a promising treatment option for pediatric IBD -associated pustular PG.

Keywords:

• pustular pyoderma gangrenosum
• acute febrile neutrophilic dermatosis
• misdiagnosis
• adalimumab

Abbreviations

PG, Pyoderma gangrenosum; IBD, inflammatory bowel disease; IgA, Immunoglobulin A; ANCA, anti-neutrophil cytoplasmic antibodies.

Ethics Approval and Consent to Participate

This case report was approved by the Ethics Committee.

Consent for Publication

Written informed consent was obtained from the patient and the patient’s parents to publish the case details and associated images.

Acknowledgments

The authors are grateful to the patient.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no competing interest in this work.

Additional information

Funding

This article has no funding support.