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Pyoderma gangrenosum in refractory celiac disease: a case report

Silvia Sedda1, Roberta Caruso1, Irene Marafini1, Elena Campione1, Augusto Orlandi12, Francesco Pallone1 and Giovanni Monteleone1*

Author Affiliations

1 Department of Systems Medicine, University of Rome “Tor Vergata”, Via Montpellier, 1, 00133 Rome, Italy

2 Department of Biomedicine and Prevention, Anatomic Pathology Unit, University of Rome “Tor Vergata”, Rome, Italy

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BMC Gastroenterology 2013, 13:162  doi:10.1186/1471-230X-13-162

Published: 27 November 2013



Pyoderma gangrenosum is an inflammatory neutrophilic dermatosis characterized by painful cutaneous ulcerations and often associated with systemic inflammatory and neoplastic diseases. Here we report the first case of pyoderma gangrenosum in a patient with refractory celiac disease.

Case presentation

A 52-year-old woman with a previously diagnosed refractory celiac disease resistant to steroids and immunosuppressive drugs presented to our hospital for a rapidly growing, painful inflammatory skin lesion of the left leg. Physical examination revealed a painful lesion with focal ulceration, necrosis and pus discharge with active inflammatory borders at the external part of the left leg. Histological evaluation of a skin biopsy and analysis of inflammatory cytokines and matrix-degrading proteases in lesional skin samples confirmed the clinical suspicion of pyoderma gangrenosum. Treatment with oral prednisone was rapidly followed by a complete healing of the skin lesion but no improvement of symptoms/signs of malabsorption.


Treatment of the patient with systemic steroids healed the skin lesion without improving the underlying refractory celiac disease. This observation raises the possibility that refractory celiac disease and pyoderma gangrenosum may be immunologically different.

Gluten; Cutaneous ulcers; Celiac disease; Pyoderma gangrenosum