Журнал клинических случаев

Coexistence of Pyoderma Gangrenosum and Cyclical Cushing’s Syndrome: A Case Report

Abstract

Sriram Shanmugam, Anjana V Dinesh and Krishna Shankar G

Pyoderma gangrenous is a rare, distinctive cutaneous ulceration which is usually idiopathic but may be associated with many systemic diseases. Currently many aspects of the underlying pathophysiology are not well understood and the etiology still remains unknown. The multiple clinical variants (classic ulcerative, pustular, bullous and superficial granulomatous) makes the diagnosis even more difficult and treating the condition is challenging as there is no clinically accepted gold standard available. Here we present the case of an unusual association of Pyoderma gangrenous and cyclical Cushing’s syndrome in a 35 year old morbidly obese female patient admitted with symptoms of breathing difficulty and bilateral all limb blisters. Her past medication history included Tab. Hydrocortisone 10 mg OD and Tab. Ketoconazole 200 mg BD. On laboratory investigation abnormal parameters found were-Haemoglobin (6.5 g/dl), vitamin D (<8.00 ng/ml), ionized calcium (3.6 mg/dl), plasma urea (53 mg/dl), AST (69 U/L), GGT (118 U/L) and serum cortisol (1.43 mcg/dl). Antibiotic therapy with injection piperacillin/tazobactam 4.5 g 3 times a day was continued for 13 days and was changed to injection meropenem 1 g 3 times a day for the next 6 days. The patient was administered with injection hydrocortisone 50 mg 4 times a day, Colchicine 0.5 g 2 times a day, Ketoconazole 200 mg 2 times a day and injection enoxaparin 60 mg/0.6 ml once daily throughout the course of stay in hospital.