Điều trị thành công một trường hợp viêm da mủ hoại thư (Thông báo lâm sàng)

Pyoderma gangrenosum (PG) represents a rare and challenging ulcerative neutrophilic dermatosis, frequently associated with underlying autoimmune and systemic conditions. Its complex and poorly understood pathogenesis, coupled with diverse clinical presentations, poses significant hurdles in both diagnosis and effective management. Given the severe impact of PG on patient quality of life and its potential for high morbidity, optimizing therapeutic strategies is of paramount importance. Despite various diagnostic tools and treatment protocols, a universally accepted standard remains elusive. This paper aims to contribute to the current knowledge by presenting a successful clinical case of Pyoderma gangrenosum, emphasizing the integrated approach to treatment and patient care.

Bác sĩ da liễu, bác sĩ phẫu thuật, bác sĩ nội khoa, và các nhà nghiên cứu y học quan tâm đến bệnh lý viêm da hiếm gặp và tự miễn.

Pyoderma gangrenosum (PG) is a rare, severe, ulcerative neutrophilic dermatosis with an incompletely understood pathogenesis, often linked to immune dysregulation and neutrophil dysfunction. Clinically, it manifests as rapidly progressive, painful skin ulcers, typically associated with systemic conditions such as inflammatory bowel disease and arthritis. The diagnostic process for PG remains challenging due to non-specific clinical and laboratory findings and the absence of a universally accepted diagnostic standard. Current therapeutic strategies for PG, which primarily include systemic corticosteroids, immunosuppressants, and biologic agents, are tailored to disease severity. This paper presents a clinical case of Pyoderma gangrenosum successfully treated in a patient who developed the condition post-appendectomy. The patient's complex journey involved initial misdiagnosis and transfer across several medical facilities before a definitive diagnosis of PG was established. The successful treatment regimen involved aggressive systemic corticosteroids, initiated intravenously and gradually tapered orally, alongside meticulous local wound care, antibiotic therapy for secondary infections, and robust nutritional support. This case underscores the vital role of a comprehensive and multidisciplinary approach in managing challenging PG cases, especially those arising after surgical trauma, which can exacerbate disease progression. The positive outcome in this case highlights that early recognition, accurate diagnosis, and a well-coordinated treatment plan, incorporating both systemic and local interventions, are crucial for achieving complete wound healing and significantly improving patient quality of life. This report contributes valuable insights into the effective management of Pyoderma gangrenosum, particularly in complex clinical scenarios.