Review Article - Understanding Pyoderma Gangrenosum: A Review

Review Article - Understanding Pyoderma Gangrenosum: A Review

from Medscape General Medicine [TM]

Further Investigations

Investigations are required to diagnose or exclude the presence of an associated systemic disease. Barium enema, upper gastrointestinal series, sigmoidoscopy, and colonoscopy may be required to exclude gastrointestinal disease. Hematologic malignancy can be excluded by a full blood count, examination of blood smear, serum and urine immunoelectrophoresis, and, in selected cases, bone marrow aspiration or biopsy.[15,16] Antineutrophilic cytoplasmic antibodies may indicate Wegener's granulomatosis, and perinuclear antineutrophilic cytoplasmic antibodies may indicate the presence of vasculitis. Other investigations, such as chest x-ray, computed tomography, and bone marrow biopsy, may be necessary depending on the past medical history and examination findings of individual patients.[16]

Syphilis serology, anticardiolipin antibody, and partial thromboplastin time should be tested routinely because gummatous syphilic ulcers and antiphospholipid syndrome can mimic PG.[3] An infectious etiology needs to be excluded. Biopsy material should be cultured for any possible bacterial, mycobacterial, or fungal cause. Stains can also be requested to exclude the presence of foreign bodies.

Systemic vasculitis is suggested by the presence of leukocytoclastic vasculitis, which is absent in PG.[7] Factitious ulcers can have a suspicious shape, or the patient may have a background history of psychiatric illness. Drug eruptions secondary to isotretinoin[17] and granulocyte colony-stimulating factor[18] can also mimic PG, and it is believed that iodine and bromide overdose can also lead to ulcers that mimic PG.[7]

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