Pyostomatitis vegetans associated with ulcerative colitis: A case report

Pyostomatitis vegetans (PV) is a rare, benign, and chronic disorder of the oral mucosa characterized by the presence of multiple pustules with an erythematous base and is an unusual oral expression of inflammatory bowel disease, such as ulcerative colitis (UC) or Crohn’s disease. Herein, a case of successful treatment for PV associated with UC is described. A 62-year-old male exhibited numerous tiny pustules and shallow erosions fusing to form characteristic “snail track” appearances were noted extensively on the gingiva. He had been diagnosed with UC five years previously and had been treated with steroid suppositories and other medications. Histological examination of a biopsy specimen of the upper left gingiva revealed a diagnosis of PV. Treatment for PV and UC was initiated with ATM therapy in which three antibiotics (amoxicillin, tetracycline and metronidazole) should be co-administered simultaneously three times a day, for two weeks. Then, the patient administered prednisolone at 30 mg/day. Two weeks later, significant improvement of oral mucosal lesions was observed. Although prednisolone was reduced gradually to 5 mg⁄ day after that, the erosions and ulcers of the rectalmucosa were not found endoscopically four months after the administration of systemic corticosteroids. Thereafter, treatment and management of UC was continued by his attending gastroenterologist, and no recurrence of PV has been observed for more than five years after the PV was cured.PV may accompany or precede active UC despite the absence of intestinal symptoms and can be used as a good mucocutaneous sign to determine the occurrence of active UC at an early stage.