Pyoderma Gangrenosum. Presented by the Dermatology Staff, Wayne State University School of Medicine.
A 44-year-old white man had a tenmonth history of a slowly enlarging ulcer over the medial aspect of the right thigh. The lesion appeared first as small tender nodules that broke down and ulcerated. The ulcer extended peripherally to form a large lesion with an irregular border. Past medical history included a partial gastrectomy in 1955 for a recurrent ulcer and mild diabetes mellitus. The patient is a heavy smoker.Physical examination revealed a large deep ulcer of the right thigh, with an irregular serpiginous outline and a ragged, bluish-red, overhanging border. The base of the ulcer was covered by necrotic areas and areas of granulation tissue. Laboratory findings included an antinuclear factor and negative lupus erythematosus preparations. The erythrocyte sedimentation rate was 90 mm/hr, and the stool guaiac test was positive. A gastrointestinal series and x-ray