Multifocal pyoderma gangrenosum involving breast and oral mucosa: a diagnostic enigma

Soham Virani, Department of Dermatology, Kims Hospital, Bhubaneswar, Odisha, India Debasmita Behera, Department of Dermatology, Kims Hospital, Bhubaneswar, Odisha, India Chinmoy Raj, Department of Dermatology, Kims Hospital, Bhubaneswar, Odisha, India Farheen Begum, Department of Dermatology, Kims Hospital, Bhubaneswar, Odisha, India

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis typically affecting the lower limbs, often associated with systemic diseases such as inflammatory bowel disease (IBD). We report a rare case of a 36-year-old female presenting with painful ulcers over atypical sites, including the left breast and tongue, alongside the buttocks, groin, thighs, and abdomen. Lesions evolved from pustules to necrotic ulcers, accompanied by fever, bloody diarrhea, and arthralgia. Histopathology revealed dense neutrophilic infiltrates; colonoscopy showed terminal ileal ulcerations consistent with IBD. Infectious causes were excluded. The patient responded well to systemic corticosteroids and cyclosporine over 3 months. This case underscores the importance of recognizing PG in uncommon sites such as the oral mucosa and breast, which may mimic other conditions. Early diagnosis and immunosuppressive treatment are vital for optimal outcomes, especially in PG associated with systemic disease.

Keywords: Pyoderma gangrenosum. Mucosal involvement. Inflammatory bowel disease.