Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Two Cases of Pyoderma Gangrenosum Associated with Recurrent Ulcerative Colitis

재발성 궤양성 대장염 환자에서 병발한 괴저고름피부증 2예

  • Kwon, Yong-Hwan (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Kim, Jae-Woo (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Park, So-Yeon (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Kim, Moon-Young (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Kim, Hyun-Soo (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Baik, Soon-Koo (Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Abdul-Ghafar, Jamshid (Department of Pathology, Yonsei University Wonju College of Medicine) ;
  • Cho, Mee-Yon (Department of Pathology, Yonsei University Wonju College of Medicine)
  • 권용환 (연세대학교 원주의과대학 내과학교실) ;
  • 김재우 (연세대학교 원주의과대학 내과학교실) ;
  • 박소연 (연세대학교 원주의과대학 내과학교실) ;
  • 김문영 (연세대학교 원주의과대학 내과학교실) ;
  • 김현수 (연세대학교 원주의과대학 내과학교실) ;
  • 백순구 (연세대학교 원주의과대학 내과학교실) ;
  • 쟘시드 압둘 가파 (연세대학교 원주의과대학 병리학교실) ;
  • 조미연 (연세대학교 원주의과대학 병리학교실)
  • Received : 2010.06.22
  • Accepted : 2010.10.16
  • Published : 2010.11.30
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Abstract

Pyoderma gangrenosum (PG) begins with a painful, erythematous skin lesion followed by pustule formation and rapid ulceration in which an erythematous border surrounds a sterile, necrotic center. In most patients, symptoms of ulcerative colitis precede PG, and exacerbations of the bowel disease frequently correlate with worsening of the skin lesions. As PG is not commonly encountered by clinicians, the diagnosis of such lesions is not always straightforward. This case emphasizes the importance of detailed history taking and the consideration of PG as a differential diagnosis of such lesions in patients with a background of related systemic disease. The prognosis of PG is generally good. But, early aggressive therapy can minimize severe complications, and maintenance treatment may prevent some devastating consequences. We report two cases of PG that developed on the entire body and on an anterior chest wall abscess with ulcerative colitis, which improved with corticosteroid and cyclosporine.

괴저고름피부증은 통증이 있는 홍반성 구진으로 시작되어 농포를 형성하고 급격하게 진행되는 무균성, 괴사성 궤양으로 발전하는 병변이다. 대부분의 환자에서 궤양성 대장염의 증상이 선행하고 장 질환의 악화는 피부 병변의 악화와 연관성을 가진다. 괴저고름피부증은 임상의에게 드문 질환이기 때문에 진단이 바로 내려지는 경우가 적다. 이 증례는 전신 질환인 궤양성 대장염에서 피부 병변의 감별진단으로 괴저고름피부증을 고려하기 위해서 세심한 병력청취가 중요함을 보여주는 경우이다. 일반적으로 괴저고름피부증의 예후는 좋은 편이나 적극적인 조기 치료는 심각한 합병증을 최소화할 수 있고 지속적인 치료는 발생할 수 있는 후유증을 막을 수 있다. 저자들은 궤양성 대장염으로 진단받은 두 명의 환자에서 전신과 전흉부에 괴저고름피부증이 발생하여 스테로이드와 사이클로스포린 치료로 호전된 증례를 경험하여서 문헌고찰과 함께 보고한다.

Keywords

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