EXTENSIVE PYODERMA GANGRENOSUM LIKE LESION IN TWO CASES OF BEHCET’S DISEASE, RESPONDING ONLY TO CYCLOSPORIN.


Abstract: Introduction: Pyoderma gangrenosum (PG) like lesion is a Behcet’s disease (BD) skin lesion, which is seen very exceptionally. We report here 2 cases with unusual severe and extensive skin lesions, having an intensive hypersensitivity to needle injection, inducing new lesions. Cases report: The first case is a 42 years old man with a history of 5 years recurrent bipolar aphthosis, skin pustulosis, ocular lesions, and articular involvement. After 3 years of remission he developed large and extensive ulcerations on the legs, buttock and back. Biopsy of the lesion showed a vasculitis. Local treatment with injection of triamcinolone acetonide induced new ulcerations after each injection. Cyclosporin was the only successful treatment. He developed a central nervous system involvement secondary to Cyclosporin. The second case is a 20-year male with a severe oro-pharynx and genital aphthosis, pustular lesions, and articular involvements. He developed large ulcerations on his leg. The biopsy showed vasculitis. Lesions responded only to Cyclosporin. Discussion: PG is a neutrophilic dermatitis with the same hypersensitivity to trauma as BD. In PG some cases are associated with bowel diseases as in BD. PG can also in some cases produce localization of neutrophilic lesions in other organs such as CNS, heart, lymph nodes. There is therefore some resemblance between PG and BD. Conclusions: The severe involvement, in one of our cases, prompt to be careful in the manipulation of PG like lesions. The only successful treatment in two cases was Cyclosporin.