Pyoderma gangrenosum.

Journal article

Jeffrey P Callen's excellent seminar on pyoderma gangrenosum,1 prompts us to report the rare occurrence of pyoderma of the cervix in a patient who attended our hospital over many years. Pyoderma gangrenosum of the vulva2 and of mucosal membranes of the mouth in patients with inflammatory bowel disease3 are well recognised, but our patient had cervical lesions.In 1982, a 58-year-old woman presented with a 5-year history of chronic, non-healing skin lesions that first developed suprapubically, and then elsewhere. These were ulcerated lesions with a violaceous edge that were occasionally painful. Our investigations found no evidence of inflammatory bowel disease, arthritides, haematological/immunological disorders, or malignant disease. Biopsy samples and tissue cultures from four lesions over the years excluded infection, vasculitis, and cancer and showed neutrophilic infiltration, suppurative granulomas, and epidermal necrosis consistent with the diagnosis of pyoderma gangrenosum.The skin lesions were resistant to treatment, but after several stays in hospital and trials of different regimens the lesions eventually healed with courses of minocycline and systemic and topical steroids. Some recurrences occurred and scarring was evident, but by 1993 she did not have any acute skin lesions.In 1996, she developed blood-stained vaginal discharge. Speculum examination revealed an erythematous thickened lesion of the posterior vaginal vault and cervix. Two biopsy samples showed no evidence of infection or malignant disease, but review of all her histology showed changes identical to those seen in the skin biopsy samples taken years before.She was treated with prednisolone as sodium phosphate suppositories and enemas inserted into the vagina. The figure shows the appearance of the cervix after treatment for 1 month. The vaginal discharge slowly resolved and the lesions gradually disappeared over 6 months. We believe that this disorder was pyoderma gangrenosum of the cervix, although it has not been previously reported at this site, and were relieved that it responded so well to treatment with topical steroids.

Authors: Powell, J; Wojnarowska, F; Charnock, M; Millard, P

• Publication status: Published
• Journal: Lancet
• Volume: 351
• Issue: 9112
• Pages: 1366
• Publication date: 1998-05-01
• DOI: 10.1016/s0140-6736(05)79108-x
• EISSN: 1474-547X
• ISSN: 0140-6736
• Language: English
• Keywords: Middle Aged; Female; Humans; Pyoderma Gangrenosum; Uterine Cervical Diseases