Pyoderma gangrenosum in a newborn - Case report
A twenty-three days old, female patient, born and living in Primavera (Pará State), was\nadmitted to the neonatal intensive care unit (NICU) presenting with "wounds" on the\nabdomen, genital area and buttocks for the last 10 days. The mother informed that the\nproblem started with a "swelling" and blisters that ruptured, originating the "wounds"\non the aforementioned areas. Dermatological examination showed ulcerated lesions, some\nwith a granular hemorrhagic base others with purulent and necrotic ones; with irregular\nand excavated borders, located on the torso and genital-inguinal-crural areas, extending\nto the buttocks ( and ). The anatomopathological examination of the biopsy\nspecimen showed an epidermis with parakeratosis, without other significant associated\nalterations. The dermis presented with a vascular ectasia and a perivascular,\ninterstitial inflammatory infiltrate of a lymphohistiocytic nature, scattered with\neosinophils and rare neutrophils. No histological marker of vasculitis was observed. The\ninfiltrate extended to the subcutaneous interstice, both in the lobular and septal\nsectors, giving the diagnoses of sub-acute superficial and deep inflammatory processes.\nWe performed cultures for bacteria on the ulcers' secretion, with a negative result. The\npatient was treated with wide-spectrum antibiotics, cephalosporin and imipenem, for\nseven days without response, at which point a dermatologic consultation was solicited,\nleading to the diagnosis of pyoderma gangrenosum. Systemic corticoid therapy (prednisone\n0.5 mg/kg/day) was then initiated with marked improvement of the lesions after ten days.\nThe patient was rapidly discharged and sent to the outpatient clinic for corticosteroid\nweaning. Presently she has only atrophic scars. ()