EC Gastroenterology and Digestive System

Introduction: Peristomal PG (PPG) is a dreaded and (fortunately) rare subtype of PG that develops on the skin adjacent to a stoma. There are few case reports describing this association. It is a challenging condition to diagnose and treat and no evidence-based guidelines exist. We report a case report of a patient with crohn's disease who had presented a peristomal pyoderma gangrenosum.

Observation: A 22-year-old woman, with a history of ileocolonic and perianal crohn's disease classified A2L3B3P according to the montreal classification, associated with ocular and articular involvement since 2014. She is currently on a combination therapy (Infliximab+ azathioprine). Due to the severity of anoperineal lesions, and non-response to combination therapy the patient underwent surgery for sigmoidal colostomy. Two years later the patient presented a peristomal PPG confirmed on histology. The treatment consisted on local corticotherapy associated with local care and parenteral nutrition, albumin human perfusions and infliximab 5 mg/kg with good clinical evolution.

Conclusion: Peristomal PG during IBD is an exceptional localization. Early diagnosis and treatment is important to avoid disease progression and subsequent patient discomfort. Its management is poorly codified and empirical.

Keywords: Peristomal Pyoderma Gangrenosum; Crohn’s Disease; Local Corticotherapy; Infliximab

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