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Clinical Note |

A Case of Pyoderma Gangrenosum on the Nasal Dorsum

Dong Hyun Kim, MD; Jeong-Hoon Oh, MD; Jong Joo Lee, MD; Hyun Jun Kim, MD
Arch Otolaryngol Head Neck Surg. 2010;136(2):193-196. doi:10.1001/archoto.2009.213.
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Pyoderma gangrenosum (PG) is a severe ulcerative skin disorder of uncertain origin but may be associated with a variety of diseases including inflammatory bowel disease, rheumatoid arthritis, and malignant neoplasms (particularly leukemia).1 Lesions most commonly affect the lower legs, while lesions in the head and neck are rare.2 Pyoderma gangrenosum involving the nose is extremely rare, with few reports of PG affecting the nose presenting as nasal septal perforation and resultant saddle nose deformity (Table).37 The condition is often disfiguring, particularly following inappropriate surgical intervention. We report herein a patient with ulcerative colitis and PG that was managed with minor surgery but resulted in a saddle nose deformity.

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Figure 1.

Examination findings of the patient before treatment. A, Nasoendoscopic findings showing an erythematous and ulcerative nasal septum (black arrow) (arrow head, inferior turbinate). B, Findings from rigid sigmoidoscopy showing severe inflammation and friable mucosa with pseudopolyposis of the large bowel. C, The erythematous, swollen, cutaneous lesion of the dorsum (black arrow) is shown just before incision and drainage. D, Direct axial computed tomographic scan of the paranasal sinus with contrast enhancement demonstrates a low-density mass and swelling at the nasal septum and the dorsum (white arrow). E, Histopathologic findings showing acute inflammation with neutrophils in the dermis (hematoxylin-eosin, original magnification ×200 [nasal skin]). F, Histopathologic findings showing crypt abscess and crypt distortion without epithelial dysplasia, consistent with ulcerative colitis (hematoxylin-eosin, original magnification ×200 [colon]).

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Figure 2.

The state of the patient's wound during treatment. A, Seven months after initial corticosteroid therapy the wound worsened with focal necrotic discharge (arrow) accompanied by painful swelling of graft site area. B, Thirteen months after initial therapy, the necrotic discharge had ceased and the state of the wound improved, although the saddle deformity (arrow) remained. C, Nasoendoscopic findings showing a healed nasal septum (arrow) (arrowhead, inferior turbinate). D, Findings from rigid sigmoidoscopy showing healing of the ulcerative colitis.

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