Granulomatosis with polyangiitis and skin ulcers mimicking pyoderma gangrenosum: A case report of a diagnostic challenge

• Published in: Revista Colombiana de Reumatología (English Edition) 2024-04, Vol.31 (2), p.268-275
• Main Authors: Navarrete-Motta, Linda, Barrios, Onaldo-José, Gil-Tamayo, Sebastián, Saaibi, Daniela, Gutiérrez, Juan M., Fernández-Ávila, Daniel G., Bernal-Macías, Santiago, Rodríguez, Jorge L., Díaz, María-Claudia
• Format: Article
• Language: English
• Subjects: Granulomatosis con poliangitis; Granulomatosis with polyangiitis; Methotrexate; Metotrexato; Piodermia gangrenoso; Pyoderma gangrenosum; Reporte de caso; Vasculitis
• ISSN: 2444-4405; 2444-4405
• DOI: 10.1016/j.rcreue.2023.05.002

Granulomatosis with polyangiitis (GPA) and pyoderma gangrenosum are rare and difficult-to-diagnose pathologies with severe manifestations and a high burden of morbidity. GPA is a necrotizing systemic vasculitis of small vessels, while pyoderma gangrenosum is an inflammatory skin disease. The aim of this study is to describe the comprehensive clinical-pathological study process necessary to accurately identify these conditions and establish an effective treatment plan. A retrospective study was conducted on a case of a patient with cutaneous lesions suspected of pyoderma gangrenosum. Clinical data, including symptoms, laboratory tests, biopsies, and imaging results, were collected. A multidisciplinary review of the findings was carried out to reach an accurate diagnosis. The treatment consisted of administering methotrexate. Following the comprehensive clinical-pathological study, the diagnosis of granulomatosis with polyangiitis associated with pyoderma gangrenosum-like lesions was confirmed. The patient responded favourably to methotrexate treatment, and the cutaneous lesions completely resolved after one year. This case illustrates the difficulty in diagnosing granulomatosis with polyangiitis and pyoderma gangrenosum, highlighting the importance of a multidisciplinary approach in their management. The comprehensive clinical-pathological study and appropriate treatment led to successful resolution of the patient’s lesions. It is crucial to promote collaboration among different medical specialties to improve the diagnosis and treatment of these rare and highly morbid diseases. La granulomatosis con poliangeítis (GPA) y el pioderma gangrenoso son patologías raras y difíciles de diagnosticar, con manifestaciones graves y una alta carga de morbilidad. La GPA es una vasculitis sistémica necrosante de pequeños vasos, y el pioderma gangrenoso es una enfermedad inflamatoria de la piel. Se busca describir el proceso de estudio clínico-patológico exhaustivo necesario para identificar correctamente estas condiciones y establecer un plan de tratamiento efectivo. Se realizó un estudio retrospectivo del caso de una paciente con lesiones cutáneas sospechosas de pioderma gangrenoso. Se recopilaron los datos clínicos, incluyendo síntomas, estudios de laboratorio, biopsias y resultados de imagen. Se llevó a cabo una revisión multidisciplinaria de los hallazgos para llegar a un diagnóstico preciso. El tratamiento consistió en la administración de metotrexato. Tras un estudi