A case of unilateral pustular pyoderma gangrenosum

A 44-year-old male who had no medical history was admitted to our hospital complaining of a four-month history of sudden-onset multiple ulcers on the left thigh. Physical examination revealed ulcerative lesions with multiple small pustules on the left thigh. Laboratory examination showed an increased number of leukocytes (13,610/mm³) with 93.2% neutrophils and elevated CRP (4.35 mg/dL). Histological examination showed neutrophilic infiltration into the mid- to lower dermis, especially around the hair follicles. The diagnosis of unilateral pustular pyoderma gangrenosum was made. Systemic prednisolone, cyclosporine A, and sulfasalazine were initiated after treatment with mini pulse steroid therapy (methylprednisolone at 500 mg/day for five days). Despite the decreased inflammatory response, the patient suffered from multiple painful ulcers, which were successfully treated with negative-pressure wound therapy (NPWT) starting 66 days after admission. Rapid re-epithelization and pain reduction could be achieved with NPWT in this case.