Pyoderma Gangrenosum in a Patient With Pancreatic Neuroendoc
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
A 55-year-old Caucasian female was diagnosed with pancreatic neuroendocrine tumor (VIPoma). She began treatment with octreotide in February 2014. She had mild disease progression and underwent peptide receptor radionuclide therapy (PRRT). She received three cycles of PRRT. Her follow-up scans showed a mixed response with mild increase and decrease in certain areas; therefore, chemotherapy with capecitabine and temozolomide was started in 2016. She then underwent a Whipple procedure in 2019 followed by radiation therapy and is currently being treated with monthly lanreotide.

The patient was transferred to our hospital for further evaluation and management of her persistent right arm wound. Her vitasl were stable and laboratory investigations were withinnormal limit. Blood cultures were negative, lactic acid was within normal limits, and wound culture showed no organisms. On physical examination, she was noted to have a large, painful ulcerated wound on the anterior aspect of her right forearm with elevated violaceous borders. The final biopsy report confirmed pyoderma gangrenosum.

Dermatology recommended daily dressing changes with Vaselineä gauze followed by Telfaä, then Kerlixä, and then tape. The wound was kept clean with warm soap and normal saline. After approximately two to three weeks of steroid therapy, a vast improvement in the appearance of the ulcer was noted. The patient reported less pain. Her lesion significantly improved on prednisone and was marked by the appearance of post-inflammatory hyperpigmentary changes during her third week on steroids.

Her lesions were healing well, and she was stable for discharge. She was prescribed 100 mg daily of oral prednisone to taper by 10 mg every five days for four weeks on discharge.