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Pyoderma Gangrenosum as a Paraneoplastic Syndrome of Transverse Colon Adenocarcinoma

Year: 2024

Type: article

Abstract: Case Presentation A 58-year-old male, hypertensive and diabetic, presented with a non-healing leg ulcer of 4 months’ duration. A biopsy of the lesion identified neutrophilic ulcerative dermatitis consistent with pyoderma gangrenosum (PG). Oral corticosteroid therapy was initiated but resulted in lesion progression. The patient also exhibited chronic anemia and a weight loss of approximately 15 kg during this period, without gastrointestinal symptoms. Diagnostic investigation included a colonoscopy, which revealed a vegetative lesion in the proximal transverse colon. Biopsy confirmed adenocarcinoma. Staging via abdominal MRI showed diffuse liver metastases, and the carcinoembryonic antigen (CEA) level was 954.85 mcg/L. Systemic chemotherapy, local wound care, and corticosteroid maintenance were recommended. Discussion PG is an ulcerative condition often associated with autoimmune systemic inflammatory diseases, such as rheumatoid arthritis and inflammatory bowel disease. Less commonly, it can present as a paraneoplastic syndrome, most frequently associated with hematologic malignancies. However, there are reports of PG linked to solid tumors, with breast cancer being the most common, followed by gastrointestinal and colorectal cancers (predominantly rectal and sigmoid tumors). To date, no cases have been reported of PG associated with transverse colon adenocarcinoma. Paraneoplastic PG ulcers typically appear before the cancer diagnosis and have a clinical course parallel to the malignancy, with the dermatological lesion expected to improve with cancer treatment. Conclusion Colorectal carcinoma should be considered a differential diagnosis in patients with PG, particularly those without known autoimmune diseases or who do not respond to specific treatment. In such cases, colonoscopy should be included in the etiological investigation. Publication History Article published online: 25 April 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Source: Journal of Coloproctology

DOI: 10.1055/s-0045-1808674