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Pyoderma Gangrenosum Initially Presenting as an Ulceration of the Ear Lobule.


Heather Grace  Dulnuan,
Carlo Victorio  Garcia,
Agnes Tirona-Remulla

Related Institution

Department of Otolaryngology - Head and Neck Surgery - Philippine General Hospital University of the Philippines Manila

Publication Information

Publication Type
Publication Sub Type
Philippine Journal of Otolaryngology Head and Neck Surgery
Publication Date
July-December 2021


Pyoderma Gangrenosum (PG) was first described in 1916 as "phagedenisme geometrique", after a French dermatologist observed rapidly progressing, cutaneous necrotic lesions with sharp borders.1 In 1930, Brunsting and his colleagues at the Mayo Clinic coined the term Pyoderma Gangrenosum, because it was initially thought to arise from staphylococcal and streptococcal infections which were observed in 5 of their patients.2 The exact etiology and pathogenesis is still unknown. To date, only a few cases of PG have been shown to affect the ears, all showing no gender or age predilection.3 We report another such case.



A three-year-old girl presented at the emergency room with a non-healing, erythematous papule over her left ear lobule, allegedly following an ear piercing one month prior. She was initially treated at another institution with oral antibiotics. Despite treatment, her mother noted rapid worsening of the lesion, eventually developing into a painful ulceration and affecting the left eyelid as well. At the time of examination, the patient presented with a painful, necrotic plaque around the left eyelid with serpiginous borders (Figure 1) and ear lobule with erythematous, advancing borders (Figure 2A, B). There were no systemic co-morbidities noted. The working diagnosis then was necrotizing fasciitis and she was immediately started on systemic intravenous antibiotics which she did not respond to. Laboratory tests showed elevated CRP, but procalcitonin, C-ANCA and ANA were all normal. Tissue cultures of both eyelid and earlobe, as well as blood cultures, revealed no growth. Wedge biopsy of the eyelid ulceration revealed neutrophilic dermatitis. Biopsy of the ear lobule revealed suppurative granulomatous dermatitis with secondary leucocytoclastic vasculitis. Further workups for infection and possible systemic diseases were all unremarkable. A pathergy test was negative. A diagnosis of pyoderma gangrenosum was made after excluding systemic and infectious causes. The patient was started on systemic prednisone at a dose of 1mg/kg/day which she slowly responded to. Surgical reconstruction of the earlobe was to be planned once the ulceration completely healed; unfortunately, this patient was lost to follow-up.


1. Farhi, D . "The clinical and histopathological description of geometric phagedenism (pyoderma gangrenosum) by Louis Brocq one century ago" Arch Dermatol 144(6): 755, June 2008
2. Brunsting, LA , Goeckerman, WH , O, PA . "Pyoderma (echthyma) gangrenosum: clinical and experimental observation in five cases occurring in adults" Arch Dermatol Syphilol 22(4): 655–680, October 1930
3. Dos Santos Sousa, MC , Lima Lemos, EF , Oliveira De Morais, O , Silva Leite Coutinho, AH , Martins Gomes, C . "Pyoderma gangrenosum leading to bilateral involvement of ears" J Clin Aesthet Dermatol 7(1): 41–43, January 2014
4. Powell, FC , Schroeter, AL , Su, Wp . "Pyoderma gangrenosum: a review of 86 patients" Q J Med 55(217): 173–186, May 1985
5. Von Den Driesch, P . "Pyoderma gangrenosum: a report of 44 cases with follow-up" Brit J Dermatol 137(6): 1000–1005, 1997
6. Adachi, Y , Kindzelskii, AL , Cookingham, G , Shaya, S , Moore, EC , Todd, RF 3rd , Petty, HR . "Aberrant neutrophil trafficking and metabolic oscillations in severe pyoderma gangrenosum" J Invest Dermatol 111(2): 259-68, August 1998
7. Schoch, JJ , Tolkachjov, SN , Cappel, JA , Gibson, LE , Davis, DM . "Pediatric pyoderma gangrenosum: A retrospective review of clinical features, etiologic associations, and treatment" Pediatr Dermatol 34(1): 39-45, January 2017
8. Kechichian, E , Haber, R , Mourad, N , El Khoury, R , Jabbour, S , Tomb, R . "Pediatric pyoderma gangrenosum: a systematic review and update" Int J Dermatol 56(5): 486-495, May 2017
9. Ruocco , E , Sangiuliano, S , Gravina, AG , Miranda, A , Nicoletti, G . "Pyoderma gangrenosum: an updated review" J Eur Acad Dermatol Venerol 23(9): 1008-17, September 2009
10. Su, WPD , Davis, MDP , Weenig, RH , Powell, FC , Perry, HO . "Pyoderma gangrenosum: clinicopathologic correlation and proposed diagnostic criteria" 790–800 43(11): November 2004
11. Snyder, RA . "Pyoderma gangrenosum involving the head and neck" Arch Dermatol 122(3): 295-302, March 1986
12. Ramos, VME , Chamberlin, CVS , Dofitas, BL . "A rare case of bullous pyoderma gangrenosum in a patient with acute myelogenous leukemia" Acta Medica Philippina 54(3): 336-339, 2020
13. Powell, FC , Perry, HO . "Pyoderma gangrenosum in childhood" Arch Dermatol 1984 120(6): 757–761, 1984

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