Pyoderma Gangrenosum Associated with Hyperzincemia

Isomura Iwao, Morita Akimichi, Sugano Shigeru, Tsuji Takuo

doi:10.14924/dermatol.111.955

We report a case of 6 year-old girl with pyoderma gangrenosum and hyperzincemia. She had been suffering from fever, elevation of CRP and liver dysfunction and followed for e latent Epstein Barr virus infection since infancy. She developed painful undermined ulcers surrounded by itchy erythema on her head, neck, and lower extremities at the age of four. Laboratory findings showed anemia, thrombopenia, and elevation of CRP. Phagocytosis of neutrophils was decreased, but T cell function was normal. Serum zinc was extremely elevated, although the urine zinc level was normal. Hepatosplenomegaly was shown in abdominal CT. Skin biopsy specimen revealed a dense infiltration of neutrophils in the dermis. A deep ulcer developed at the biopsied site. We diagnosed this case as pyoderma gangrenosum and started systemic steroid therapy. We could not find any inflammatory bowel disease, lymphoproliferative disorder, autoimmune disease, or severe immunodeficiency. Recently, hyperzincemia has been reported in immunocompromised cases, in some of whom cutaneous lesions, pyoderma gangrenosum, and vasculitis have appeared. We describe herein an association between hyperzincemia and pyoderma gangrenosum with a review of the literature.

Pyoderma Gangrenosum Associated with Hyperzincemia

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