Pyoderma gangrenosum (External abscess due to Colitis)

Question: I was wondering if anyone here has experienced external abscesses that might be associated to their colitis flareup? I am currently towards the END of a flare-up. Abscesses are hard to deem Pyoderma Gangrenosum because you must medically exclude what the wound ISN'T before you can diagnose it as such.

I currently have a 1-inch abscess in my bikini region. Thought it was an ingrown hair. It progressed into an abscess very quickly. It definitely looks like the stuff of nightmares now. I can message photos if anyone is curious.

Steps taken so far

• Abscess formation started March 7.
  
• Saw an Urgent Care doctor Monday March 12, she issued antibiotics and took a culture.
  
• By Friday March 16, the abscess grew/got worse. Was not responding to treatment. Culture came back negative for bacterial growth.
  
• Checked in to a General Practitioner on Friday, March 16. She stated that most abscesses are bacterial in nature, and this case was very strange. So she prescribed a Clobetasol Propionate (steroid) ointment and calcium alginate dressing (to dry out the wound).

Future Steps

• I am getting blood drawn on March 19.
  
• My next Gastroenterologist appointment is not until March 27.

It seems the medical staff I have encountered thus far is very unfamiliar with non-bacterial abscess treatment. And I had to self-diagnose with the GP based off of my supplemental knowledge of my own disease. And before my blood levels get back and I get to a Gastro, I am still not 100% sure if this abscess is undergoing the proper course of treatment. But any help I get from you guys is greatly appreciated.

Current Status I am taking Sulfasalazine (3000mg/day) and Prednisone (20mg/day). Applying Clobetasol Propionate daily to abscess. I am 120lbs, female.

Thank you in advance.


UPDATE 3/18 When changing dressing, there is no raised red ridge around the perimeter of lesion. The affected lesion is no longer red and bloody/pus-filled. It is light pink. There is less pain. The topical steroid treatment could be a factor in this! I will try to keep this post updated in hopes that it will help other people!

UPDATE 3/24 Visited the Dermatologist, and he immediately diagnosed the lesion as Pyoderma Gangrenosum. He injected the site with Lidocaine, then a Steroid. It's getting better every day.

I also talked with my Gastroenterologist, and she is putting me on Remicade infusions. The Remicade will help with the Colitis AND the Pyoderma Gangrenosum.

Post Edited (rabbitlover) : 3/23/2018 10:52:15 PM (GMT-6)

I thought this kind of thing was a Crohn's feature?

It's in my bikini area. It's right between my leg and crotch region. There is no similarity between an external fistula and this lesion. Its size is a little over 1 inch long, oval-shaped.

It does not appear necrotic or green/gangrenous. It is fleshy, red/bloody, with very little pus (possibly due to the steroid ointment).The lesion perimeter is well-defined.

MRSA and bacterial growth was ruled out. There was no bacteria on the culture taken.

Currently, I'm on the third day of treatment with a topical steroid ointment. The lesion/abscess has not grown, but it has not begun to shrink either.

While pyoderma gangrenosum typically appears on the legs, it is possible to appear in different areas. It seems to be an abscess that forms as a secondary complication in conjunction with autoimmune diseases, according to my GP. But it is hard to diagnose, because all other diagnoses must be ruled out first. But, like I said, I don't have a Gastro appointment until the 27th, and I'm trying to get it treated now before I have to take drastic steps, like check in to ER.

I have taken a photo every day at the time I change the dressing.

I can message someone a photo if they're interested in viewing it, or if they need to see it. (Not that any of you are doctors, but if you've been through something similar, you can tell me what I could expect!)

I am going to try to make an appointment with a dermatologist as well. Is there any other specialist I should consider that might understand what's going on?

Thank you, guys, for your replies.

Post Edited (rabbitlover) : 3/18/2018 8:27:22 AM (GMT-6)

I get what you are describing an in that area and a few other places, but it has happened for 15 years, well before my diagnosis. Sometimes the abscesses turn into larger lesions that take a few weeks to go away (especially in the bikini area -- it is warm and clothes irritate it). I was diagnosed with hidradenitis suppurativa, which is an inflammatory disease of the skin and there are studies that show a high incidence of IBD in people with HS.

I have a colleague at work with UC and RA and who suffers from PG from time to time. This person’s legs are quite scarred from lesions, some of them are the size of small saucers. Sounds like you are in the right path as far as treatment is concerned. Hope you heal quickly.

quincy said...
It sounds as though you are caring for the ulceration with extreme caution, and that's good. Taking pics are also good.

Is it possible you can get in to your GI sooner by calling with distress, desperation and beg to get in. Hopefully, he can make a call and get you into a dermo specialist asap.

Post in the CD forum as well.

hugs,
q

Thank you, Quincy. I will call on Monday and see if I can get more immediate treatment with a local dermatologist! I will also update my GP and let her know of my progress. And I will call the Gastro and see if they can squeeze me in sooner, as well.

Yes, I have been taking great care with this wound. Thank you for your response!

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