Caputo and Colleagues recently published a case report in JAMA Dermatology Clinicopathological Challenge, “Peristomal Erosion in a Man With Crohn Disease.” It’s available open access.
The case is of a man in his 50’s with a 10-year history of Crohn’s disease who had intermittent bowel obstructions leading to total proctocolectomy and ileostomy. Five weeks after his surgery, he developed a painful, erosive lesion around his stoma on the anterior abdominal wall. Despite topical potent steroids and topical tacrolimus, the erosion expanded. No additional cutaneous or mucosal lesions were present. I glanced at this while I was traveling and thought to myself, “Oh it’s so great they are bringing attention to the problem of peristomal pyoderma gangrenosum.” Except, spoiler alert, it’s not pyoderma! Biopsy findings were consistent with localized pemphigus vulgaris.
I have to admit, I have never done a biopsy of the painful peristomal lesions that I have treated – and now I am embarrassed. In retrospect, using the PARACELSUS scoring system, they meet the criteria for PG, but I am posting this JAMA case report to remind everyone (including me) that every atypical peristomal lesion is not PG.
Above is a case of peristomal PG that I treated, which you can compare to the case report of the patient with localized pemphigus vulgaris.
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
