Pyoderma gangrenosum

QUESTION 33

A 57-year-old Caucasian man with a history of Crohn’s disease presents to the gastroenterology clinic with a peristomal ulceration. The ulcer is intensely tender and has grown larger and more painful within the last 3 weeks. He was referred to the dermatology clinic, where he presented with a bright red exophytic nodule on the abdomen with an adjacent gun-metal grey ulcerated plaque (33). An incisional punch biopsy was performed at the edge of the ulceration and histopathologic examination revealed ulceration with a neutrophilic inflammatory infiltrate without granulomatous inflammation. The patient’s past medical history is notable for a subtotal colectomy for medically refractory Crohn’s disease.