Pyoderma gangrenosum complicated by cerebral abscesses in an HIV-infected patient

Abstract

Pyoderma gangrenosum (PG) is a rare ulcerative neutrophilic disease that usually affects the skin, with rare extracutaneous involvement. A few cases associated with HIV have been reported. We report a case with cerebral manifestations in the form of an abscess. A 35-year-old woman presented with a chronic ulceration of the left thigh that had been evolving for 6 months. The onset was progressive, marked by a pustule that became ulcerated, extending centrifugally and painfully. She had had multiple consultations with no improvement. Examination revealed an ulcero-necrotic lesion 6cm in diameter, with an infiltrated edge that was painful to palpate. Elsewhere, there were no particularities. Anatomopathological examination confirmed PG, serology tests were positive for HIV1, T-CD4 count was at 283 cells/mm³, and the viral load at 299 copies/ml. The patient was started on prednisone 1mg/kg/day and antiretrovirals, with good improvement after 3 weeks. Headache and left focal signs followed. Aetiologies of an intracranial expansive process were sought but were negative, and CT showed cerebral abscesses. The patient died five days later. In the case of PG, it is important to look for associated pathologies, particularly in the brain.

Received: April 29^th, 2024

Accepted: August 16^th, 2024

https://dx.doi.org/10.4314/aamed.v17i4.17