Overview
Pyoderma gangrenosum (PG) is a rare inflammatory skin condition that can rapidly destroy tissue when it affects the eyelid, and it is often mistaken for infection. The authors report a teenager with ulcerative colitis whose upper eyelid ulcer worsened despite antibiotics for presumed infection, until a PARACELSUS diagnostic score and other clinical findings supported starting steroid treatment for PG before biopsy results were back.
Findings
- Patient: 17-year-old with ulcerative colitis, progressive upper eyelid ulceration, initially treated as preseptal cellulitis and later suspected necrotizing infection.
- Broad-spectrum antibiotics given; the lesion worsened.
- PARACELSUS score of 17, plus sterile cultures and associated skin lesions, supported a diagnosis of pyoderma gangrenosum.
- Systemic corticosteroid therapy started immediately, before histopathology confirmed the diagnosis.
- Adjunctive treatment: topical hypochlorous acid wound therapy and ophthalmic antibiotic ointment.
- Histopathology later confirmed pyoderma gangrenosum.
- Complete re-epithelialization (skin healing) within 3 weeks.
- No eyelid malposition, functional problem or recurrence during 8 months of follow-up.
What it means for a patient
- An eyelid ulcer that does not respond to antibiotics, especially in a patient with inflammatory bowel disease, can be pyoderma gangrenosum rather than an infection.
- A scoring tool (PARACELSUS) helped this team start the right treatment, systemic steroids, before waiting for biopsy confirmation, which matters because PG can destroy eyelid tissue quickly.
- With prompt steroid treatment and gentle wound care, the eyelid healed fully within 3 weeks with no lasting deformity through 8 months of follow-up.
- This is a single patient case.
Why this paper matters
It shows a diagnostic score can support early, tissue-sparing steroid treatment for periocular pyoderma gangrenosum before biopsy confirmation, preventing the eyelid damage this disease can otherwise cause.
Terms
- Pyoderma gangrenosum: a rare inflammatory skin disease causing painful, rapidly enlarging ulcers, not caused by infection.
- PARACELSUS score: a scoring system that supports diagnosing pyoderma gangrenosum from clinical features.
- Preseptal cellulitis: infection of the eyelid tissue in front of the orbital septum.
- Hypochlorous acid therapy: a topical antimicrobial wound-care solution.
- Re-epithelialization: the skin surface healing over with new cells.
- Ulcerative colitis: an inflammatory bowel disease linked to pyoderma gangrenosum.