A case of malignant pyoderma with neurological manifestations

Abstract

A case of malignant pyoderma with a fatal course is presented. A 62-year-old Chinese man was admitted with a 8-month history of progressive ulcerative nodular skin lesions starting on the right antecubital fossa and spreading to the chest, face, arms and legs. The lesions failed to respond to many antibiotics. Examination revealed multiple large crusted foul-smelling ulcers with erythematous raised vegetative edges and tender erythematous nodules. Investigations showed an anaemia of chronic disease and an erythrocyte sedimentation rate of 135mm/1st hour. Histology showed multiple circumscribed microabscesses in the upper dermis. The skin lesions responded well to systemic corticosteroid therapy. Three months after admission, he developed multiple cranial nerve palsies, and severe progressive peripheral neuropathy. Radiographic studies revealed cavitating lesion in the right upper lobe consistent with a diagnosis of carcinoma of the lung. Five months after admission, patient was intubated for stridor but he succumbed to aspiration pneumonia. Malignant pyoderma should be considered if an ulcer fails to respond to antibiotics, and possible neurological complications should be thought of.