P4412 - Unveiling the Uncommon: Pyoderma Gangrenosum as an Extraintestinal Complication of Ulcerative Colitis

Eric Nguyen, MD, JD¹, Caleb M. Glover, DO², Gisela Ocasio, DO¹, Albert Ross, MD^1
1McLaren Greater Lansing Hospital, Lansing, MI; ²McLaren Greater Lansing Hospital, East Lansing, MI

Introduction: Pyoderma Gangrenosum is an uncommon inflammatory and ulcerative skin disorder characterized by neutrophil accumulation within the skin. It presents as single or multiple erythematous papules or pustules on the skin; however, it can coalesce to form extensive ulcerations. It is also the second most common dermatologic manifestation of IBD, usually in the lower extremities. However, the proportion of patients with IBD who develop pyoderma gangrenosum is exceedingly small. It has only been detected in less than 1% of patients with IBD. Here, we present a very rare presentation of pyoderma gangrenosum on the abdomen, with only a few other cases described in the literature. Given its rare but unique presentation, clinicians must know how to recognize it when it presents itself.

Case Description/Methods: We present a case of a 66-year-old female with a history of hypothyroidism and hypertension who presented to the ED for nonhealing abdominal wounds. The wounds began seven weeks prior to presentation with a small pustule, progressing to erythema and swelling. Despite multiple debridements and antibiotics, she experienced worsening symptoms. She also reported a history of progressively worsening bloody diarrhea for 2.5 years. Upon admission, the patient’s wound dramatically progressed in size and level of discomfort despite debridement and several courses of antibiotics. After a thorough investigation and extended hospital admission that included CT imaging, multiple abdominal wound debridements, wound biopsy, and finally, colonoscopy with biopsies, she was diagnosed with ulcerative colitis with extraintestinal manifestation of pyoderma gangrenosum. The patient was then started on high-dose steroids and eventually infliximab due to the complexity of her case at presentation.

Discussion: This case underscores the rarity of pyoderma gangrenosum presenting on the abdomen as an extraintestinal manifestation of ulcerative colitis, contrasting with its more typical presentation on the lower extremities. Early diagnosis is crucial for promptly initiating appropriate treatment, which can significantly improve patient outcomes. This case emphasizes the necessity for healthcare providers to maintain a high index of suspicion for pyoderma gangrenosum in patients with IBD, particularly when encountering nonhealing wounds or atypical dermatological manifestations, ensuring timely intervention and improved quality of care.


Disclosures:


Eric Nguyen, MD, JD¹, Caleb M. Glover, DO², Gisela Ocasio, DO¹, Albert Ross, MD¹. P4412 - Unveiling the Uncommon: Pyoderma Gangrenosum as an Extraintestinal Complication of Ulcerative Colitis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.