Clinical Endoscopy

  • 제41권5호
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  • Pages.312-318
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  • 2010
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  • 2234-2400(pISSN)
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  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
권호 표지

재발성 궤양성 대장염 환자에서 병발한 괴저고름피부증 2예

Two Cases of Pyoderma Gangrenosum Associated with Recurrent Ulcerative Colitis

  • 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)
  • 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)
  • 투고 : 2010.06.22
  • 심사 : 2010.10.16
  • 발행 : 2010.11.30
⟨ 이전 논문 다음 논문 ⟩

초록

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.

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.

키워드

참고문헌

  1. Yuksel I, Basar O, Ataseven H, et al. Mucocutaneous manifestations in inflammatory bowel disease. Inflamm Bowel Dis 2009;15:546-550. https://doi.org/10.1002/ibd.20807
  2. Veloso FT. Review article: skin complications associated with inflammatory bowel disease. Aliment Pharmacol Ther 2004;20(suppl 4):50S-53S.
  3. Johnson ML, Wilson HT. Skin lesions in ulcerative colitis. Gut 1969;10:255-263. https://doi.org/10.1136/gut.10.4.255
  4. Futami H, Kodaira M, Furuta T, Hanai H, Kaneko E. Pyoderma gangrenosum complicating ulcerative colitis: successful treatment with methylprednisolone pulse therapy and cyclosporine. J Gastroenterol 1998;33:408-411. https://doi.org/10.1007/s005350050104
  5. Regueiro M, Valentine J, Plevy S, Fleisher MR, Lichtenstein GR. Infliximab for treatment of pyoderma gangrenosum associated with inflammatory bowel disease. Am J Gastroenterol 2003;98:1821-1826. https://doi.org/10.1111/j.1572-0241.2003.07581.x
  6. Ruocco E, Sangiuliano S, Gravina AG, Miranda A, Nicoletti G. Pyoderma gangrenosum: an updated review. J Eur Acad Dermatol Venereol 2009;23:1008-1017. https://doi.org/10.1111/j.1468-3083.2009.03199.x
  7. Funayama Y, Kumagai E, Takahashi K, Fukushima K, Sasaki I. Early diagnosis and early corticosteroid administration improves healing of peristomal pyoderma gangrenosum in inflammatory bowel disease. Dis Colon Rectum 2009;52:311-314. https://doi.org/10.1007/DCR.0b013e31819accc6
  8. Jung SA, Yang SK, Jung HY, et al. Two cases of pyoderma gangrenosum associated with inflammatory bowel disease. Korean J Gastrointest Endosc 1997;17:847-852.
  9. Kim DH, Oh JH, Lee JJ, Kim HJ. A case of pyoderma gangrenosum on the nasal dorsum. Arch Otolaryngol Head Neck Surg 2010;136:193-196. https://doi.org/10.1001/archoto.2009.213
  10. Park CH, Chun HJ, Jeen YT, et al. Pyoderma gangrenosum on the sternal area in ulcerative colitis. Korean J Gastrointest Endosc 2002;25:470-474.
  11. Cho HL, Chang YW, Cho YS, et al. A case of pyoderma gangrenosum associated with inactive ulcerative colitis. Korean J Gastrointest Endosc 1998;18:597-603.
  12. Seo HD, Na CH, Chung BS, Choi KC, Shin BS. A case of post-traumatic pyoderma gangrenosum associated with ulcerative colitis. Korean J Dermatol 2008;46:487-490.
  13. Menachem Y, Gotsman I. Clinical manifestations of pyoderma gangrenosum associated with inflammatory bowel disease. Isr Med Assoc J 2004;6:88-90.
  14. Seok JH, Park JC, Kwun SW, et al. Pyoderma gangrenosum in ulcerative colitis. Korean J Gastrointest Endosc 1999;19:300-305.
  15. Okuma K, Mitsuishi K, Hasegawa T, Tsuchihashi H, Ogawa H, Ikeda S. A case report of steroid and immunosuppressantresistant pyoderma gangrenosum successfully treated by granulocytapheresis. Ther Apher Dial 2007;11:387-390. https://doi.org/10.1111/j.1744-9987.2007.00498.x
  16. Brooklyn TN, Dunnill MG, Shetty A, et al. Infliximab for the treatment of pyoderma gangrenosum: a randomised, double blind, placebo controlled trial. Gut 2006;55:505-509. https://doi.org/10.1136/gut.2005.074815
  17. Papageorgiou KI, Mathew RG, Kaniorou-Larai MG, Yiakoumetis A. Pyoderma gangrenosum in ulcerative colitis: considerations for an early diagnosis. BMJ 2005;331:1323-1324. https://doi.org/10.1136/bmj.331.7528.1323
  18. Aseni P, Di Sandro S, Mihaylov P, Lamperti L, De Carlis LG. Atypical presentation of pyoderma gangrenosum complicating ulcerative colitis: rapid disappearance with methylprednisolone. World J Gastroenterol 2008;14:5471-5473. https://doi.org/10.3748/wjg.14.5471
  19. Callen JP. Pyoderma gangrenosum. Lancet 1998;351:581-585. https://doi.org/10.1016/S0140-6736(97)10187-8
  20. Ermis F, Ozdil S, Akyuz F, Pinarbasi B, Mungan Z. Pyoderma gangrenosum treated with infliximab in inactive ulcerative colitis. Inflamm Bowel Dis 2008;14:1611-1613. https://doi.org/10.1002/ibd.20481