Pyoderma penile gangrenosum – some dramatic skin disease

Pyoderma gangrenosum (PG) is a reactive inflammatory skin disease that falls within the spectrum of neutrophilic dermatoses. Neutrophilic dermatoses are histopathological due to a normal infiltrate of management of polymorphonuclear leukemia and, among others, with other systemic limitations.

PG gives four confidential types: ulcerative, the most pustular, bullous and vegetative. 2 ulcerative It develops rapidly and can be very large. PG occurs right on the other extremities, but any skin or mucocutaneous site can be. One of the interests of the penis is closure, but since the penis is a very sensitive area for tissue, prompt diagnosis and treatment is important.

We report the case of a self-confident 17-year-old boy who was referred by our urologist for a genital ulcer in our ward as part of an unhealed urethral fistula after two plastic reconstructions with skin grafts.

A year before his presentation in our department, the patient had a supporting ulcer in the development of the glans neck which extends to the frenulum. She has been prescribed topical treatment with betamethasone valerate and fucidic acid and the lesion may be different. After 1 month there was still a little erosion in the brake and it was decided to cut the brake. After the procedure, the ulcer developed. To overcome healing, surgical debridement was performed, which included worsening the lesion and the formation of a urethral fistula. Plastic reconstruction of the fistula with a foreskin skin graft did not improve and the graft was not rejected. The plastic reconstruction of the fistula with a skin graft failed again and the patient was referred to one of our departments for consultation 1 month after the second operation.

The relevant examination was purulent circulatory ulceration, glans, glans neck and adjacent foreskin and adjacent penile shaft. The edge of the lesion was edematous and purple. A suprapubic catheter was present. There was no lymphadenopathy. The patient denied any sexual intercourse and any history of trauma. His personal and family history is linked to the war.

The following tests were normal: blood cell count, urinalysis, kidney and liver function tests, serum immunoglobulin, antinuclear effects, antineutrophilic cytoplasmic effects, syphilis serology, herpes simplex virus, herpes simplex virus, human immunodeficiency, hepatitis B and C viruses, aerobic and anaerobic bacterial cultures, polymerase chain therapy for Mycobacterium tuberculosis from injured tissue, chest x-ray and colonoscopy. A biopsy had been lost to us before it was presented and had chronic mild inflammation of the dermis with the majority of polymorphonuclear leukemia.

That is why the treatment and worsening of the injury after surgery and the absence of infection or neoplasia were prescribed to patients and treatment with 250 mg of cyclosporine and 16 mg of ethyl prednisolone.

Prednisone was active after 3.5 months. Improvement in lesion warfare was noticeable from the first week of treatment. The suprapubic catheter was removed after 2 months. Four months after the start of treatment and the patient was still taking 250 mg of cyclosporine, the lesion area was free from contacts of inflammation or ulcers, but of fistulas or malignant tumors. Under the urethral fistula, Crohn’s disease was diagnosed as a diagnosis, but was lost because the biopsy did not reveal any non-biting granuloma and surgical treatment of the ulcer was related to the lesion. Colonoscopy also does not distinguish between abnormal results.

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