Pyoderma Gangrenosum and Haematochezia in A Patient with Previous Cocaine Abuse.
4 affiliations
- 1Internal Medicine Department, Nicosia General Hospital, Nicosia, Cyprus.
- 2Rheumatology Clinic, Nicosia General Hospital, Nicosia, Cyprus.
- 3Histopathology Department, Nicosia General Hospital, Nicosia, Cyprus.
- 4Medical School, University of Cyprus, Nicosia, Cyprus.
Abstract
Introduction
Pyoderma gangrenosum (PG) is an autoinflammatory neutrophilic dermatosis that may rarely occur in association with granulomatosis with polyangiitis (GPA). Management of refractory disease remains challenging.Case description
A 48-year-old man with a history of previous cocaine abuse was admitted due to impaired feeding in the context of a chronic hard palate perforation and a large oro-sinus fistula. During hospitalisation, he developed haematochezia and painful ulcerative skin lesions involving the right upper limb and lower extremities. Upper and lower gastrointestinal endoscopy revealed a Forrest IIc gastric lesion and a non-bleeding ileocecal ulcer. Histopathological examination of skin lesions demonstrated dense neutrophilic infiltration consistent with PG, while gastrointestinal biopsies excluded inflammatory bowel disease. An extensive evaluation excluded infection, antiphospholipid syndrome, cryoglobulinaemia, malignancy and vascular occlusive disease, all of which may mimic PG. Autoimmune screening workup yielded positive for anti-proteinase-3 antibodies (C-ANCA). The patient initially received high-dose methylprednisolone followed by mycophenolate mofetil and infliximab. Despite treatment, disease activity persisted with recurrent relapses, requiring hospitalisations. Upadacitinib was subsequently introduced, resulting in rapid clinical improvement, near-complete healing of skin lesions and successful glucocorticoid withdrawal.Conclusion
The coexistence of PG and GPA is rare and presents substantial diagnostic and therapeutic challenges. JAK inhibition with upadacitinib may represent a promising therapeutic option in refractory cases.Learning points
Pyoderma gangrenosum may rarely coexist with granulomatosis with polyangiitis, creating significant diagnostic and therapeutic challenges.A history of cocaine abuse may complicate the diagnostic evaluation because cocaine-induced vasculitis can mimic ANCA-associated vasculitis.Upadacitinib may represent a promising steroid-sparing therapeutic option in refractory pyoderma gangrenosum associated with granulomatosis with polyangiitis.Pyoderma gangrenosum is a diagnosis of exclusion for which no confirmatory test exists; approximately 10% of patients given the diagnosis are subsequently found to have an alternative condition, so mimickers must be actively excluded before and during treatment.
Related
- Incidence, Prevalence and Diagnostic Delay in Pyoderma Gangrenosum: A Finnish Nationwide Registry-based Study.
- Pyoderma gangrenosum chez une femme de 26 ans.
- Successful Treatment of Recalcitrant Pyoderma Gangrenosum with Baricitinib in Two Patients with Rheumatoid Arthritis.
- Refractory Idiopathic Infantile Pyoderma Gangrenosum Successfully Treated With Infliximab: A Case Report.
- Pyoderma gangrenosum and sickle cell vaso-occlusive crisis: fortuitous association or causal relationship ?: a case report
BibTeX
@article{hadjicharalambous2026pyoderma,
title = {{Pyoderma Gangrenosum and Haematochezia in A Patient with Previous Cocaine Abuse.}},
author = {Myrianthi Hadjicharalambous and Sofia Symeonidou and George Georgiou and Chara Azina and Antreas Ioannou},
journal = {European journal of case reports in internal medicine},
year = {2026},
month = oct,
doi = {10.12890/2026_007405},
url = {https://europepmc.org/article/MED/43011654},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Pyoderma Gangrenosum and Haematochezia in A Patient with Previous Cocaine Abuse.
AU - Myrianthi Hadjicharalambous
AU - Sofia Symeonidou
AU - George Georgiou
AU - Chara Azina
AU - Antreas Ioannou
PY - 2026
DA - 2026/10/14
JO - European journal of case reports in internal medicine
DO - 10.12890/2026_007405
UR - https://europepmc.org/article/MED/43011654
AB - Introduction Pyoderma gangrenosum (PG) is an autoinflammatory neutrophilic dermatosis that may rarely occur in association with granulomatosis with polyangiitis (GPA). Management of refractory disease remains challenging.Case description A 48-year-old man with a history of previous cocaine abuse was admitted due to impaired feeding in the context of a chronic hard palate perforation and a large oro-sinus fistula. During hospitalisation, he developed haematochezia and painful ulcerative skin lesions involving the right upper limb and lower extremities. Upper and lower gastrointestinal endoscopy revealed a Forrest IIc gastric lesion and a non-bleeding ileocecal ulcer. Histopathological examination of skin lesions demonstrated dense neutrophilic infiltration consistent with PG, while gastrointestinal biopsies excluded inflammatory bowel disease. An extensive evaluation excluded infection, antiphospholipid syndrome, cryoglobulinaemia, malignancy and vascular occlusive disease, all of which may mimic PG. Autoimmune screening workup yielded positive for anti-proteinase-3 antibodies (C-ANCA). The patient initially received high-dose methylprednisolone followed by mycophenolate mofetil and infliximab. Despite treatment, disease activity persisted with recurrent relapses, requiring hospitalisations. Upadacitinib was subsequently introduced, resulting in rapid clinical improvement, near-complete healing of skin lesions and successful glucocorticoid withdrawal.Conclusion The coexistence of PG and GPA is rare and presents substantial diagnostic and therapeutic challenges. JAK inhibition with upadacitinib may represent a promising therapeutic option in refractory cases.Learning points Pyoderma gangrenosum may rarely coexist with granulomatosis with polyangiitis, creating significant diagnostic and therapeutic challenges.A history of cocaine abuse may complicate the diagnostic evaluation because cocaine-induced vasculitis can mimic ANCA-associated vasculitis.Upadacitinib may represent a promising steroid-sparing therapeutic option in refractory pyoderma gangrenosum associated with granulomatosis with polyangiitis.Pyoderma gangrenosum is a diagnosis of exclusion for which no confirmatory test exists; approximately 10% of patients given the diagnosis are subsequently found to have an alternative condition, so mimickers must be actively excluded before and during treatment.
SN - 2284-2594
ER -