Pyoderma gangrenosum Associated With Cocaine Abuse

Abstract: A 36-year-old man presented with pyoderma gangrenosum associated with cocaine abuse. The patient presented to our department with a 2-week history of ulceration on the left forearm at a skin graft donor site following surgical intervention to repair a perforation of the nasal septum and palate due to cocaine abuse of at least 10 years’ duration—an estimated dosage of up to 2 g/day. Standard medications and additional substance abuse were not described in the patient’s medical history.

Address correspondence to: Joachim Dissemond, MD Department of Dermatology University School of Medicine, Essen Hufelandstraße 55 45122 Essen, Germany Phone: +49-2017233894 E-mail: joachimdissemond@hotmail.com
 

Case Report

     A 36-year-old man presented with pyoderma gangrenosum associated with cocaine abuse. The patient presented to our department with a 2-week history of ulceration on the left forearm at a skin graft donor site following surgery to repair a perforation of the nasal septum and palate due to cocaine abuse of at least 10 years’ duration. The patient’s medical history did not reveal other standard medications or other substance abuse. The patient took up to 2.4 g ibuprofen/day for pain.      The clinical inspection revealed a 30 cm x 10 cm painful ulceration with undermined violaceous borders (Figure 1). Perilesional biopsy showed a non-specific diffuse dermal neutrophilic infiltrate and ulceration without vasculitis. The diagnosis of a pyoderma gangrenosum was made and the patient was started on systemic therapy with prednisolone and cyclosporine A. In the following months, a recurrent progression with relapses of the pyoderma gangrenosum under immunosuppressive therapy was found that correlated with the patient’s intermittent cocaine abuse. Complete wound closure was achieved after 8 months of treatment (Figure 2).

Discussion

     The correlation of cocaine abuse and vasculitis is well described.^1–3 These observations lead to the assumption that cocaine abuse may cause modulation of certain immune functions. This theory is supported by other cases, which demonstrated the coherence of increased risk for infectious disease in chronic drug abusers assembly caused by drug-mediated immunmodulation.⁴ Recently, Roche et al⁵ reported for the first time on the association of two regular cocaine users with pyoderma gangrenosum. Distinct pyoderma gangrenosum is often challenging to manage and usually requires systemic therapy. Moreover, it is essential for the prognosis to identify, and if possible, treat the underlying diseases respectively associated factors like drugs.

Conclusion

     This case is remarkable for the rarely described association of pyoderma gangrenosum and cocaine abuse. Clinicians who treat patients with chronic wounds should be well informed regarding this association.