Pyoderma gangrenosum, as the first clinical presentation of systemic lupus erythematous, a case report and comprehensive literature review.

Abstract

Background: Pyoderma gangrenosum (PG) can be related to a range of systemic and hematologic diseases. The relationship between systemic lupus erythematosus (SLE) and PG has rarely been discussed.

Case presentation: In this case study, we report on an SLE patient who presented with PG. The patient is a 53-year-old woman with the chief complaint of developing painful erythematous pustules on her right flank 3 days after hysterectomy surgery. In the span of 3 months, the patient was treated with antibiotics and intra-lesional corticosteroids with no improvement. Meanwhile, she developed symptoms such as polyarthralgia, pleural effusion, hemolytic anemia, and thrombocytopenia, while anti-dsDNA came out positive.

Result: Based on pathology results in combination with clinical and para-clinical findings according to the SLICC criteria for SLE 2012, our patient was diagnosed as an active case of SLE presenting with PG. We also searched for and gathered the latest articles on this issue (from 2017 until 2022) to present the most updated review study on the topic in this article.

Conclusion: Considering the abundance of PG and SLE concomitance reported cases (more than 30), it might be time to pay more attention to SLE as the underlying cause of PG and keep in mind that any unhealing ulcer in patients with connective tissue disorders should be evaluated for PG. Considering the various treatment options for PG, it is essential that the treatment of choice should cover symptoms of both PG and the underlying disease.