Jeffrey Callen MD, Professor of Medicine (Dermatology),
Chief, Division of Dermatology, Department of Medicine, University
of Louisville School of Medicine, Louisville, KY, USA
on Dec 31, 2006
The child should be evaluated for inflammatory bowel disease.
In addition, if not already done, cultures for AFB and fungi
should be performed. Treatment with infliximab is useful, even
in the absence of IBD. IVIG in my opinion is unlikely to be
effective.
I have a child with chronic and recurrent PG since age 4 - both
cyclosporin and infliximab have been helpful, but we have not
identified an associated process.
Shahbaz Janjua MD, Specialist Dermatologist, Ayza Skin
& Research Center, Lalamusa, Pakistan on December
31, 2006
This is really an impressive case of PG.
I recently treated PG in a 12-year-old boy. He primarily had
untreated scabies which got complicated by superaded bacterial
infection over a period of one month. He presented with very
painful large ulcerated oozing lesions with undermined borders
on the extremities. Treatment with topical and oral antibiotics
had been unhelpful. I treated this patient with oral prednisolone,
ciprofloxacillin, and topical fusidic acid cream. I also prescribed
topical permethrin to the patient and all the contacts. A dramatic
recovery was seen in one week.
In my opinion many patients would respond to treatment with
oral steroids without any need to prescribe other immunosuppressive
agents.
Robert I. Rudolph, M.D., FACP, Clinical Professor of
Dermatology, University of Pennsylvania, Philadelphia. PA, USA
on December 31, 2006
Wow! I tend to agree with the diagnosis, but the ferocity and
widespread nature of the lesions makes me very worried about
an underlying systemic disease - especially hematologic - despite
negative studies at this time. This kid needs very close followup.
I'd also consider a halogenoderma, or atypical erosive Sweet's.
I would have said, incidentally, that the buttock lesions were
artefactual if they had been the only spots present. Good Luck.
Bushan Kumar MD, Professor of Dermatology, Departtment
of Dermatology,
Postgraduate Institute of Medical Education and Research, Chandigarh,
India on Janaury 4, 2007
Interesting case report. The diagnosis is by exclusion as the
disease is very uncommon in children - but the clinical picture
is quite characteristic. Just a little query in the history
of 2 years. Has the lesions been persisting all along? From
the line “developed a rapidly progressing painful ulcer
on the right leg ‘again’ it seems to indicate that
there were no previous lesions.
Why did the patient report to the orthopedic surgeon on both
occasions - some joint symptoms as well? Or some other reason?
Histopathological changes in the gut can be present even in
the absence of clinical symptoms. In the present episode course
of the disease seems to be rather fulminant - any systemic symptoms?
I feel steroids give good results. Immunosuppressives could
be added if the response was inadequate with steroids alone.
Henry Foong FRCP, Ipoh, Malaysia on January
21, 2007
This present episode is a relapse of the disease which started
about 2 years ago. He was then treated with oral prednisolone
but defaulted partly because he developed cushigoid features
as a result of the oral corticosteroids treatment.
For this present episode, he was successfully treated with
cyclosporin and oral prednisolone with minimal cushigoid features
and the dose has been reduced to cyclosporin 100mg daily and
prednisolone 5 mg daily. The rest of the perianal lesions has
healed completely.
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