Pyoderma gangrenosum: a rare cause of an orbital ulcer

Abstract

Pyoderma gangrenosum is a rare neutrophilic dermatosis. The most common presentation is an inflammatory papule or pustule that progresses to a painful ulcer with violaceous borders and purulent base. It is an exclusion diagnosis and there are no pathognomonic findings. The authors describe a case of a 46-year-old Caucasian male presented with progressive swelling of the right supraciliary complicated with skin ulceration for the last 2 months. He had had an accidental trauma in that area about 4 years ago with an iron cable. Upon clinical examination, he had skin nodules that subsequently formed erosions and non-exudative skin ulceration of the right eyelid. Magnetic resonance revealed an expansive lesion extending to the plane of the superior orbital fissure and the optic nerve canal, involving the medial rectus muscle and intra-conical fat. A diagnosis of orbital cellulitis was assumed and the patient performed multiple antibiotics without improvement. Lesion biopsy excluded both neoplasia and infection. Histology revealed neutrophilic dermatosis. The injury worsened with time. A diagnosis of Pyoderma Gangrenosum was presumed and the patient started on prednisolone 1mg/kg/day and azathioprine 100mg/day, after excluding concomitant rheumatological, hematological and neoplastic disease. Unfortunately, the patient died after a few months.