Pyoderma gangrenosum: a review with special emphasis on Latin America literature<sup>,</sup>

Rodríguez-Zúñiga, Milton José Max; Heath, Michael S.; Gontijo, João Renato Vianna; Ortega-Loayza, Alex G.

doi:10.1016/j.abd.2019.06.001

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Review • An. Bras. Dermatol. 94 (6) • 2019 • https://doi.org/10.1016/j.abd.2019.06.001 copy

Pyoderma gangrenosum: a review with special emphasis on Latin America literature^☆ ☆ How to cite this article: Rodríguez-Zúñiga MJM, Heath MS, Gontijo JRV, Ortega-Loayza AG. Pyoderma gangrenosum: a review with special emphasis on Latin America literature. An Bras Dermatol. 2019;94:729-43. ^,^☆☆ ☆☆ Study conducted at the Oregon Health and Sciences University, Portland, United States; and at the Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Pyoderma gangrenosum is a neutrophilic dermatosis characterized by chronic ulcers due to an abnormal immune response. Despite the existence of diagnostic criteria, there is no gold standard for diagnosis or treatment. In Latin America, recognizing and treating pyoderma gangrenosum is even more challenging since skin and soft tissue bacterial and non-bacterial infections are common mimickers. Therefore, this review aims to characterize reported cases of pyoderma gangrenosum in this region in order to assist in the assessment and management of this condition. Brazil, Mexico, Argentina, and Chile are the countries in Latin America that have reported the largest cohort of patients with this disease. The most frequent clinical presentation is the ulcerative form and the most frequently associated conditions are inflammatory bowel diseases, inflammatory arthropaties, and hematologic malignancies. The most common treatment modalities include systemic corticosteroids and cyclosporine. Other reported treatments are methotrexate, dapsone, and cyclophosphamide. Finally, the use of biological therapy is still limited in this region.

KEYWORDS
Inflammatory bowel diseases; Latin America; Pyoderma gangrenosum; Skin ulcer

Database	PubMed: (https://www.ncbi.nlm.nih.gov/pubmed/) Date: October 23rd, 2018.		Results
Strategy	#1	Search (chile OR brazil OR peru OR brasil OR colombia OR mexico OR ecuador OR venezuela OR uruguay OR cuba OR puerto rico OR costa rica OR latin america OR argentina)	702779
	#2	Search Pyoderma Gangrenosum[tiab]	2853
	#3	Search (#1 AND #2)	61
Database	LILACS (http://pesquisa.bvsalud.org/portal/) Date: October 23rd, 2018.		Results
Strategy	#1	(tw:(pyoderma gangrenosum)) AND (instance:"regional") AND (db:("LILACS"))	141

	Total (n)	%	Ulcerative	Granulomatous	Pustular	Bullous
Brazil	96	41.38	76	3	1	3
Argentina	69	29.74	57	2	2	3
Bolivia	1	0.43	1	-	-	-
Chile	21	9.05	20	-	1	-
Colombia	16	6.90	14	-	-	-
Costa Rica	1	0.43	1	-	-	-
Cuba	2	0.86	1	1	-	-
Mexico	17	7.33	5	1	-	-
Paraguay	1	0.43	-	-	-	1
Peru	5	2.16	2	-	1	2
Venezuela	3	1.29	2	1	-	-
TOTAL	232	100	179	8	5	9
%	100	-	77.16	3.45	2.16	3.88

Condition	n	%
IBD
No specified	11	7.4
UC	32	21.5
CD	10	6.7
Subtotal	53	35.6
Malignancy
Hematologic malignancy	14	9.4
Solid-organ malignancy	5	3.4
Subtotal	19	12.8
Inflammatory
Antiphospholipid syndrome	15	10.1
Rheumatoid arthritis	17	11.4
Lupus erythematosus	4	2.7
Takayasu's arteritis	4	2.7
Other	14	9.4
Subtotal	54	36.2
Other conditions
Pulmonary nodules	5	3.4
Cocaine consumption	2	1.3
Diverticular disease	2	1.3
Pregnancy	2	1.3
Other	12	8.1
Subtotal	23	15.4
Total	149	64.5^a a Total of patients with comorbidities/total of patients with PG × 100.
Secondary to surgery
Reduction mammoplasty	9	22.5
Laparotomy	6	15.0
Abdominoplasty	4	10.0
Skin grafts	4	10.0
Total surgery	37	16.0^b b Total of patients with PG secondary to surgery/total of patients with PG × 100. IBD, inflammatory bowel disease; UC, ulcerative colitis; CD, Crohn's disease.

n	Author	Year	Country	Number of patients	Clinical type	Associated disease	Secondary to surgery or drugs
1	Corti et al.⁵⁹59 Corti RE, Outeda JL, Boerr LA, Bai JC, Corti RN. Pioderma gangrenoso en enfermedades de Crohn del colon. Acta Gastroenterol Latinoam. 1981;11:383-90.	1981	Argentina	1	Ulcerative	Crohn's disease	No
2	Della-Giovanna et al.⁶⁰60 Della Giovanna P, Mion S, Poledore I, Torre J, Cabrera HN. Pioderma gangrenoso: a propósito de 4 casos uno asociado embarazo. Arch Argent Dermatol. 1991;41:261-70.	1991	Brazil	4	Ulcerative	Two patients with ulcerative colitis, one with pregnancy	No
3	Moreno et al.⁶¹61 Moreno JLC, Oliva JA, Pardo Hidalgo RA. Piodermia gangrenosa y artritis reumatoidea. Rev Argent Reumatol. 1994;5:69-72.	1994	Argentina	2	Ulcerative	Two patients with rheumatoid arthritis	No
4	Vignale et al.⁶²62 Vignale RA, Theophile R, Riveiro C, Abulafia J. Pioderma gangrenosum asociado a anticuerpos antifosfolípidos: a propósito de 4 casos. Arch Argent Dermatol. 1996;46:209-18.	1996	Argentina	4	Ulcerative	Three patients with Crohn's disease, two with seronegative arthritis, and one with ulcerative colitis	No
5	Saraceno et al.⁶³63 Saraceno EF, Simionato C, Sánchez G, Coradini N. Pioderma gangrenoso: a propósito de 6 casos. Arch Argent Dermatol. 2002;52:143-52.	2002	Argentina	6	Ulcerative	One patient with myelodysplastic syndrome, one with rheumatoid arthritis, one with hemophagocytic syndrome and hepatitis C	No
6	Plaza⁶⁴64 Plaza MG. Pioderma gangrenoso en el geronte asociado a colagenopatias: a proposito de un caso. Rev Argent Dermatol. 2004;85:220-6.	2004	Argentina	1	Ulcerative	Rheumatoid arthritis	No
7	Simon et al.⁶⁵65 Simón S, Rivarola E, Abaca H. Pioderma gangrenoso periestomal. Dermatol Argent. 2005;11:31-4.	2005	Argentina	1	Ulcerative	Ulcerative colitis	Peristomal after total colectomy
8	Vazquez et al.⁶⁶66 Vázquez FJ, Oria I, Saucedo C, Freue J, Aguera D. Pioderma gangrenoso y osteomielitis crónica: una rara asociación. Rev Hosp Ital B Aires (2004). 2009;29:97-8.	2009	Argentina	1	Ulcerative	Chronic osteomyelitis	Knee prosthesis replacement
9	Sommerfleck et al.⁶⁷67 Sommerfleck FA, Schneeberger EE, Suarez Lissi MA, Chiardola F, Sambuelli A, Marconi O, et al. Manifestaciones reumatológicas y sistémicas en pacientes con enfermedad inflamatoria intestinal. Rev Argent Reumatol. 2014;25:36-9.	2014	Argentina	1	Not reported	Ulcerative colitis	No
10	Achenbach et al.⁶⁸68 Achenbach RE, Sánchez GF, Marina S, Dutto M, Boytenko S, Maggi C. Pioderma gangrenoso extendido asociado a enfermedad de Crohn tratada con adalimumab. Rev Argent Dermatol. 2014;95:36-40.	2014	Argentina	1	Ulcerative	Crohn's disease	Sulfasalazine
11	Curmona et al.⁶⁹69 Curmona MC, Chiesura VC, Garay IS, Kurpis M, Ruiz Lascano A. Pioderma gangrenoso. Dermatol Argent. 2014;20:164-8.	2014	Argentina	2	Ulcerative	One patient with metastatic ovarian cancer	Abdominal tumor resection
12	Pereyra et al.⁷⁰70 Pereyra S, Martínez C, Cano M, Consigli J, Ponssa G. Pioderma gangrenoso en paciente trasplantado renal: respuesta al tratamiento con tacrolimus tópico. Dermatol Argent. 2014;20:56-9.	2014	Argentina	1	Ulcerative	Renal transplant	No
13	Fassi et al.⁷¹71 Fassi MV, Chiesura V, Valente E, Kurpis M, Ruiz Lascano A. Úlcera en pierna en un paciente con artritis reumatoidea y colitis ulcerosa: ¿vasculitis reumatoidea o pioderma gangrenoso ulceroso?: Rheumatoid vasculitis or ulcerous pyoderma gangrenosum? Rev Argent Dermatol. 2015;96:52-64.	2015	Argentina	1	Ulcerative	Rheumatoid arthritis and ulcerative colitis	No
14	Silva-Feistner et al.⁷²72 Silva-Feistner M, Correa GH, Hasbún AP, Vial V. Pioderma gangrenoso como complicación de cicatriz de cesárea: comunicación de un caso y revisión de literatura. Rev Argent Dermatol. 2015;96:43-51.	2015	Argentina	1	Ulcerative	None	Cesarean
15	Galimberti et al.⁷³73 Galimberti RL, Vacas AS, Bollea Garlatti ML, Torre AC. The role of interleukin-1beta in pyoderma gangrenosum. JAAD Case Rep. 2016;2:366-8.	2016	Argentina	1	Ulcerative	Ulcerative colitis	No
16	Vacas et al.¹1 Vacas AS, Torre AC, Bollea-Garlatti ML, Warley F, Galimberti RL. Pyoderma gangrenosum: clinical characteristics, associated diseases, and responses to treatment in a retrospective cohort study of 31 patients. Int J Dermatol. 2017;56:386-91.	2017	Argentina	27	Ulcerative	Ten patients with IBD, seven with hematologic malignances, five with rheumatoid or seronegative arthritis, and one with cocaine consumption	No
				2	Bullous
				2	Pustular
17	Vega et al.⁷⁴74 Vega STDdl, Ortega IJ, Figueroa CE, Rojas FC. Pioderma gangrenoso post-quirúrgico: reporte de un caso en paciente con fibrosis retroperitoneal. Rev Argent Dermatol. 2018;99:1-10.	2018	Argentina	1	Ulcerative	Retroperitoneal fibrosis	Exploratory mid-laparotomy
18	Vacas et al.⁷⁵75 Vacas AS, Bollea-Garlatti ML, Torre AC, Galimberti RL. Bullous pyoderma gangrenosum as a predictor of hematological malignancies. An Bras Dermatol. 2018;93:133-4.	2018	Argentina	1	Bullous	Acute and chronic myeloid leukemia	No
19	Pires et al.⁷⁶76 Pires AMKS, Weiss PB, Weissbluth ML, Ramos MC, Hampe SV, Bakos L. Pioderma gangrenoso associado a hepatite crônica ativa. An Bras Dermatol. 1987;62:15-8.	1987	Brazil	1	Ulcerative	Chronic hepatitis	No
20	Lana et al.⁷⁷77 Lana MA, Moreira PR, Neves LB. Wall-eyed bilateral internuclear ophthalmoplegia (Webino syndrome) and myelopathy in pyoderma gangrenosum. Arq Neuropsiquiatr. 1990;48:497-501.	1990	Brazil	1	Ulcerative	Multiple sclerosis	No
21	Pessato et al.⁷⁸78 Pessato S, Bonamigo RR, Leite CM, Brodt C, Sperhacke C, Bakos L. Piodema gangrenoso: uma revisão de cinco anos em um hospital universitário. Rev AMRIGS. 1996;40:49-51.	1996	Brazil	9	Not reported	Five patients with comorbidities	No
22	Souza et al.⁷⁹79 Souza CdS, Chioss MPdV, Takada MH, Foss NT, Roselino AMF. Pioderma gangrenoso: casuística e revisão de aspectos clínico-laboratoriais e terapêuticos. An Bras Dermatol. 1999;74:465-72.	1999	Brazil	11	Predominantly ulcerative	One patient with ulcerative colitis, one with rheumatoid arthritis, one with Grave's disease, one with diabetes mellitus	No
23	Cabral et al.⁸⁰80 Cabral VLR, Miszputen SJ, Catapani WR. Anticorpo anticitoplasma de neutrófilos (ANCA) em pioderma gangrenoso, um marcador sorológico para associação com doenças sistêmicas: estudo de oito casos. An Bras Dermatol. 2004;79:39-44.	2004	Brazil	4	Ulcerative	Four patients with ulcerative colitis, one with additional primary sclerosing cholangitis, one with seronegative arthritis	No
24	Martinez et al.⁸¹81 Martinez CAR, Priolli DG, Ramos RFB, Nonose R, Schmidt KH. Remissão completa do pioderma gangrenoso após colectomia total em doente portador de retocolite ulcerativa inespecífica. Arq Med ABC. 2005;30:106-10.	2005	Brazil	1	Ulcerative	Ulcerative colitis	No
25	Costa et al.⁸²82 Costa IMC, Nogueira LS-C. Pioderma gangrenoso e artrite reumatóide: relato de caso. An Bras Dermatol. 2005;80:81-2.	2005	Brazil	1	Ulcerative	Rheumatoid Arthritis	No
26	Fraga et al.⁸³83 Fraga JCS, Souza VLd, Valverde RV, Gamonal A. Pioderma gangrenoso: apresentação atípica. An Bras Dermatol. 2006;81.S305-S8.	2006	Brazil	1	Superficial granulomatous	Psoriasis	No
27	Coltro et al.⁸⁴84 Coltro PS, Valler CS, Almeida PCCd, Gomez DdS, Ferreira MC. O papel da patergia no pioderma gangrenoso em áreas doadoras de enxertos cutâneos: relato de caso. Rev Soc Bras Cir Plást (1997). 2006;21:231-5.	2006	Brazil	1	Ulcerative in donor site	None	Skin graft for varicose ulcers
28	Batista et al.⁸⁵85 Batista MD, Fernandes RL, Rocha MADd, Ikino JK, Pinheiro RF, Chauffaille MdLLF, et al. Pioderma gangrenoso bolhoso e síndrome mielodisplásica. An Bras Dermatol. 2006;81:S309-12.	2006	Brazil	1	Bullous	Myelodysplastic syndrome	No
29	Meyer et al.⁸⁶86 Meyer TN. Pioderma gangrenoso: grave e mal conhecida complicação da cicatrização. Rev Soc Bras Cir Plást (1997). 2006;21:120-4.	2006	Brazil	1	Ulcerative	Crohn's disease	Infraumbilical median laparotomy
30	Franca et al.⁸⁷87 Franca AE, Salvino LK, Leite SH, Ferraz JG, Rocha TD, Cintra ML, et al. Pyoderma gangrenosum as first clinical manifestation of gastric adenocarcinoma. J Eur Acad Dermatol Venereol. 2006;20:440-1.	2006	Brazil	1	Ulcerative	Gastric adenocarcinoma	No
31	Burkieviecz et al.⁸⁸88 Burkieviecz CJC, Schmidt L, Silva MB, Skare TL. Pioderma gangrenoso e lúpus eritematoso sistêmico. Rev Bras Reumatol. 2007;47:296-9.	2007	Brazil	1	Ulcerative	Systemic lupus erythematosus/antiphospholipid syndrome	No
32	Barbato et al.⁸⁹89 Barbato MT, Bakos L, Masiero NCMS, Bolson P. Perfil clinicopatológico dos pacientes com pioderma gangrenoso do Hospital das Clínicas de Porto Alegre (RS) ‒ Brasil (2000-2006). An Bras Dermatol. 2008;83:431-6.	2008	Brazil	13	Ulcerative	Two patients with Crohn's disease, two with diabetes, two with collagenosis, one with leukemia.	No
				2	Superficial granulomatous
				1	Bullous
33	Tinoco et al.⁹⁰90 Tinoco MP, Tamler C, Maciel G, Soares D, Avelleira JC, Azulay D. Pyoderma gangrenosum following isotretinoin therapy for acne nodulocystic. Int J Dermatol. 2008;47:953-6.	2008	Brazil	1	Ulcerative	Acne	Isotretinoin
34	Dornelas et al.⁹¹91 Dornelas MT, Guerra MCdS, Maués GL, Luiz JOMP, Arruda FRd, Corrêa MdPD. Pioderma gangrenoso: relato de caso. HU Rev. 2008;34:213-6.	2008	Brazil	1	Ulcerative	None	Reduction mammoplasty and abdominoplasty
35	Bonamigo et al.⁹²92 Bonamigo RR, Behar PR, Beller C, Bonfa R. Pyoderma gangrenosum after silicone prosthesis implant in the breasts and facial plastic surgery. Int J Dermatol. 2008;47:289-91.	2008	Brazil	1	Ulcerative	None	Breast implant with silicone prosthesis and facial surgery
36	Coelho et al.⁹³93 Coelho LF, Correia FG, Ottoni FA, Santos FPST, Pereira LB, Lanna CCD. Pyoderma gangrenosum: a challenge to the rheumatologist. Rev Bras Reumatol. 2009:49.	2009	Brazil	2	Ulcerative	Inflammatory arthritis/splenomegaly	No
37	Berbert et al.⁹⁴94 Berbert ALCV, Mantese SAdO, Rocha A, Rezende J, Cunha TFR. Pioderma granulomatoso superficial: relato de caso de variante rara do pioderma gangrenoso. An Bras Dermatol. 2009;84:285-8.	2009	Brazil	1	Superficial granulomatous	None	Donor site after skin grafting for burns.
38	Furtado et al.⁹⁵95 Furtado JG, Furtado GB. Pioderma gangrenoso em mastoplastia e abdominoplastia. Rev Bras Cir Plást. 2010;25:725-7.	2010	Brazil	1	Ulcerative	None	Reduction mammoplasty and abdominoplasty
39	Avelar et al.⁹⁶96 Avelar JTC, Sempértegui A, Bronzat E, Farmetano R, Ferrari B, Moscardini LMdO, et al. Pioderma gangrenoso após quadrantectomia de mama comradioterapia intraoperatória: relato de caso. Rev Bras Mastol. 2011;21:86-90.	2011	Brazil	1	Ulcerative	Breast cancer	Breast quadrantectomy and radiotherapy
40	Fonseca et al.⁹⁷97 Fonseca CB, Motta GL, Rampazzo A, Cantarelli Junior JC, Fagundes RB. Pyoderma gangrenosum as a initial manifestation of ulcerative proctocolitis. J Coloproctol (Rio J., Impr). 2011;31:301-5.	2011	Brazil	1	Bullous	Ulcerative colitis	No
41	Grillo et al.⁹⁸98 Grillo MA, Cavalheiro TT, da Silva Mulazani M, Rocha JL, Semchechen D, da Cunha CA. Postsurgical pyoderma gangrenosum complicating reduction mammaplasty. Aesthetic Plast Surg. 2012;36:1347-52.	2012	Brazil	1	Ulcerative	None	Reduction mammoplasty
42	Maia et al.⁹⁹99 Maia CBdC, Felix F, Paes V, Azevedo JAd, Grangeiro ERN, Riccio JLN, et al. Perfuração de septo nasal em paciente com pioderma gangrenoso. Int Arch Otorhinolaryngol (Impr). 2012;16:278-81.	2012	Brazil	1	Ulcerative	Cocaine use	No
43	Cunha et al.¹⁰⁰100 Cunha VS, Magno V, Wendt LR, Furian TQ, Passos EP. Pyoderma gangrenosum postlaparoscopy: a rare complication. Surg Laparosc Endosc Percutan Tech. 2012;22:e45-7.	2012	Brazil	1	Ulcerative	None	Laparoscopy
44	Bittencourt et al.¹⁰¹101 Bittencourt MdeJ, Soares LF, Lobato LS, Mancano AD, Leandro HS, Fonseca DM. Multiple cavitary pulmonary nodules in association with pyoderma gangrenosum: case report. An Bras Dermatol. 2012;87:301-4.	2012	Brazil	1	Ulcerative	Pulmonary nodules	No
45	Andrade et al.¹⁰²102 Andrade P, Brites MM, Figueiredo A. Synchronous pyoderma gangrenosum and inflammatory bowel disease, healing after total proctocolectomy. An Bras Dermatol. 2012;87:637-9.	2012	Brazil	1	Ulcerative	Inflammatory bowel disease	No
46	Carvalho et al.¹⁰³103 Carvalho LR, Zanuncio VV, Gontijo B. Pyoderma gangrenosum with renal and splenic impairment - case report. An Bras Dermatol. 2013;88:150-3.	2013	Brazil	1	Ulcerative	Splenic and renal impairment	No
47	Kruger et al.¹⁰⁴104 Kruger NA, De Marchi JJ, Souza MMd. Biological therapy for pyoderma gangrenosum. J Coloproctol (Rio J, Impr). 2013;33:232-5.	2013	Brazil	1	Ulcerative	Ulcerative colitis	No
48	Soares et al.¹⁰⁵105 Soares JM, Rinaldi AE, Taffo E, Alves DG, Cutaiti RdCC, Estrada EdOD. Pioderma gangrenoso pós-mamoplastia redutora: relato de caso e discursão. Rev Bras Cir Plást. 2013;28:511-4.	2013	Brazil	1	Ulcerative	None	Reduction mammoplasty and abdominoplasty
49	Beber et al.¹⁰⁶106 Beber AAC, Knob CF, Shons KRR, Neumaier W, Silva JCNd, Monticielo OA. Pioderma gangrenoso associado à artrite reumatoide: descrição de caso. Rev Bras Reumatol. 2014;54:322-5.	2014	Brazil	1	Ulcerative	Rheumatoid arthritis	No
50	Marchiori et al.¹⁰⁷107 Marchiori E, Hochhegger B, Guimarães M, Zanetti G. A cutaneous ulceration with pulmonary mass; 2014.	2014	Brazil	1	Ulcerative	Pulmonary nodules	No
51	Rosseto et al.¹⁰⁸108 Rosseto M, Costa SCD, NarvÁEz PLV, Nakagawa CM, Costa GOD. Pioderma gangrenoso em abdominoplastia: relato de caso. Rev Bras Cir Plást. 2015;30:654-7.	2015	Brazil	1	Ulcerative	None	Abdominoplasty
52	de Souza et al.¹⁰⁹109 de Souza EF, da Silva GA, Dos Santos GR, Motta HL, Cardoso PA, de Azevedo MC, et al. Pyoderma gangrenosum simulating necrotizing fasciitis. Case Rep Med. 2015;2015:504970.	2015	Brazil	1	Ulcerative	Myelodysplastic syndrome	No
53	Sempertegui et al.¹¹⁰110 Sempértegui A, Vasquez ISV, Fernandes Neto ALRG, Santos LMLd, Alvarenga BCF, Ueda WJ, et al. Pioderma gangrenoso após quadrantectomia de mama com radioterapia intraoperatória: relato de caso. Rev Bras Cir Plást. 2015;30:138-42.	2015	Brazil	1	Ulcerative	Breast cancer	Breast quadrantectomy and radiotherapy
54	Soncini et al.¹¹¹111 Soncini JA, Grassi Salles A, Frizzo Neto JA, Gemperli R. Successful treatment of pyoderma gangrenosum after augmentation mastopexy using vacuum therapy. Plast Reconstr Surg Glob Open. 2016;4:e1072.	2016	Brazil	1	Ulcerative	None	Augmentation mastopexy
55	Dantas et al.⁵⁵55 Dantas SG, Quintella LP, Fernandes NC. Exuberant pyoderma gangrenosum in a patient with autoimmune hepatitis. An Bras Dermatol. 2017;92:114-7.	2017	Brazil	1	Ulcerative	Autoimmune hepatitis	No
56	Freitas et al.¹¹²112 Freitas VMP, Pereira SM, Enokihara M, Cestari S. Pyoderma gangrenosum associated with left iliac vein compression syndrome: presentation of difficult diagnosis. An Bras Dermatol. 2017;92:129-31.	2017	Brazil	1	Ulcerative	Iliac vein compression syndrome	No
57	Gabe et al.¹¹³113 Gabe MB, Borchardt BC, Barella RP, Schipanski CV, Filho AMdS, Antero DC. Pioderma gangrenoso associado à poliartrite piogênica. ACM Arq Catarin Med. 2018;47:216-21.	2018	Brazil	1	Ulcerative	Pyogenic arthritis	No
58	Bittencourt et al.¹¹⁴114 Bittencourt MCB, Atanazio MJ, Xavier EM, Costa SF. Postsurgical pyoderma gangrenosum after an autologous stem cell transplantation for multiple myeloma. BMJ Case Rep. 2018;2018.	2018	Brazil	1	Ulcerative	Multiple myeloma	Autologous stem cell transplantation and then laparoscopic cholecystectomy
59	Clemente et al.¹¹⁵115 Clemente G, Silva CA, Sacchetti SB, Ferriani VPL, Oliveira SK, Sztajnbok F, et al. Takayasu arteritis in childhood: misdiagnoses at disease onset and associated diseases. Rheumatol Int. 2018;38:1089-94.	2018	Brazil	2	Ulcerative	Two patients with atypical Takayasu's arteritis	No
60	Perez et al.¹¹⁶116 Pérez L, López P, González R, Améstica O, Urbina F, Benavides A. Pioderma gangrenoso postcesária. Rev Chil Obstet Ginecol. 2001;66:28-33.	2001	Chile	2	Ulcerative	None	Cesarean
61	Lopez de Maturana et al.⁵⁴54 Lopez de Maturana D, Amaro P, Aranibar L, Segovia L. Pyoderma gangrenosum: report of 11 cases. Rev Med Chil. 2001;129:1044-50.	2001	Chile	3	Ulcerative	Two patients with diverticular disease, one patient with Crohn's disease, one patient with rheumatoid arthritis	No
				1	Pustular
62	Hevia et al.¹¹⁷117 Hevia CH, Suárez MJ, Vergara AMT. Pioderma periileostómico: caso clínico. Rev Med Chil. 2004;132:747-9.	2004	Chile	1	Ulcerative	Ulcerative colitis	Peristomal after total colectomy
63	Eulufi et al.¹¹⁸118 Eulufí MA, Calderón OW, Piñeros BJL, Silva CM, Cuadra CA, Léniz MP, et al. Pioderma gangrenosa en cirugía plástica: comunicación de tres casos. Rev Med Chil. 2006;134:339-44.	2006	Chile	3	Ulcerative	None	Two patients after skin graft, one patient after reduction mammoplasty
64	Calderon et al.¹¹⁹119 Calderón HP, Silva PP, Valenzuela AF, Poniachik TJ, Catalán L, Morales HC. Pioderma gangrenoso en paciente con colitis ulcerosa tratada con infliximab. Rev Chil Dermatol. 2011;27:199-202.	2011	Chile	1	Ulcerative	Ulcerative colitis	No
65	Fernandez-Castillo et al.¹²⁰120 Fernández Castillo R, Fernández Gallegos R, Cañadas de la Fuente GA, González Jiménez E, El Hamed HH. Pioderma gangrenoso en un paciente con insuficiencia renal crónica sobre fístula arteriovenosa secundaria a granulomatosis de Wegener: estudio de un caso. Rev Nefrol Diál Traspl. 2012;32:222-6.	2012	Chile	1	Ulcerative	Wegener granulomatosis/chronic kidney disease	Arteriovenous fistula
66	Gosch et al.¹²¹121 Gosch CM, Guaya IP, Medina KMR, Stefanazzi M, Pinilla PJ, Leyton MG, et al. Pioderma gangrenoso de la mama: reporte de un caso y revisión de la literatura. Rev Chil Dermatol. 2012;28:439-43.	2012	Chile	1	Ulcerative	None	Reduction mammoplasty
67	Melo and Fernandez ¹²²122 Melo Grollmus R, Fernandez de Retana P. Pyoderma gangrenosum following foot and ankle surgery: a case report. Foot Ankle Int. 2013;34:745-8.	2013	Chile	1	Ulcerative	None	Foot and ankle surgery
68	Calderon et al.¹²³123 Calderón OW, Cisternas VJP, Calderón MD, Eulufi MA, Guler GK, Jaramillo RL, et al. Pioderma gangrenoso en mamoplastía de reducción con pedículo inferior. Rev Chil Cir. 2013;65:541-8.	2013	Chile	3	Ulcerative	None	After reduction mammoplasty
69	Bannura et al.¹²⁴124 Bannura CG, Barrera EA, Melo LC. Pioderma gangrenoso gigante de curso fulminante asociado a enfermedad inflamatoria intestinal. Rev Chil Cir. 2014;66:259-63.	2014	Chile	1	Ulcerative	Ulcerative colitis	Laparotomy/ileostomy
70	Erlij et al.¹²⁵125 Erlij D, Cuellar C, Rivera A, Badilla N, Moldenhauer N, Foster C, et al. Oligoarthritis, panniculitis and pyoderma gangrenosum associated with non-Hodgkin lymphoma Report of one case. Rev Med Chil. 2018;146:534-7.	2018	Chile	1	Ulcerative	Erythema induratum and large B-cell non-Hodgkin's lymphoma	No
71	Penaloza et al.¹²⁶126 Peñaloza A, Amaya L, Olmos E, Piña R, Moreno C, Franco F. Colitis ulcerativa idiopatica asociada con pioderma gangrenoso: reporte de un caso. Rev Colomb Gastroenterol. 1988;3:151-3.	1988	Colombia	1	Ulcerative	Ulcerative colitis	No
72	Restrepo et al.¹²⁷127 Restrepo PAJ, Farfán QY, Angarita O, Cifuentes S, Hormaza N, Marulanda JC, et al. Colitis ulcerativa asociada con manifestaciones cutáneas. Rev Colomb Gastroenterol. 2006;21:300-5.	2006	Colombia	2	Ulcerative	Two patients with ulcerative colitis	No
73	Jaime-Lopez et al.¹²⁸128 Jaimes-Lopez N, Molina V, Arroyave JE, Vasquez LA, Ruiz AC, Castano R, et al. Development of pyoderma gangrenosum during therapy with infliximab. J Dermatol Case Rep. 2009;3:20-3.	2009	Colombia	1	Ulcerative	Ulcerative colitis	Infliximab
74	Cañas et al.¹²⁹129 Canas CA, Duran CE, Bravo JC, Castano DE, Tobon GJ. Leg ulcers in the antiphospholipid syndrome may be considered as a form of pyoderma gangrenosum and they respond favorably to treatment with immunosuppression and anticoagulation. Rheumatol Int. 2010;30:1253-7.	2010	Colombia	7	Ulcerative	Seven patients with antiphospholipid syndrome	No
75	Cadavid et al.¹³⁰130 Cadavid M, Palacios Isaza CP, Molina AL, Gómez LM, Restrepo R. Pioderma gangrenoso: reporte de caso. Med UPB. 2012;31:59-62.	2012	Colombia	1	Ulcerative	Ulcerative colitis	None
76	Severiche et al.¹³¹131 Severiche DF, Velandia O, Saldarriaga EL. Pioderma gangrenoso como síndrome paraneoplásico de un tumor tipo Phyllodes borderline. Acta Med Colomb. 2014;39:207-10.	2014	Colombia	1	Ulcerative	Breast phyllodes tumor (paraneoplastic)	No
77	Acon-Ramirez et al.¹³²132 Acón-Ramírez E, Argüello-Ruiz D. Pioderma gangrenoso ulceroso asociado a artritis reumatoide: reporte de caso. Acta Med Costarric. 2017;59:28-31.	2017	Costa Rica	1	Ulcerative	Rheumatoid arthritis	No
78	Moreira-Preciado et al.¹³³133 Moreira Preciado M, Díaz Almeida JG, Pérez López A. Pioderma gangrenoso vegetante asociado con insuficiencia renal. Rev Cubana Med Trop. 2001;53:212-6.	2001	Cuba	1	Superficial granulomatous	Renal failure	No
79	Hernandez-Urra et al.¹³⁴134 Hernadez Urra MdC, Hernandez Cubas M, Monteagudo Hernandez KY. Colitis ulcerativa y pioderma gangrenoso. Medicentro (Villa Clara). 2010:14.	2010	Cuba	1	Ulcerative	Ulcerative colitis	No
80	Zonana-Nacach et al.¹³⁵135 Zonana-Nacach A, Jimenez-Balderas FJ, Martinez-Osuna P, Mintz G. Intravenous cyclophosphamide pulses in the treatment of pyoderma gangrenosum associated with rheumatoid arthritis: report of 2 cases and review of the literature. J Rheumatol. 1994;21:1352-6.	1994	Mexico	2	Not reported	Two patients with rheumatoid arthritis	No
81	Reynoso-von Dratein et al.⁵⁸58 Reynoso-von Drateln C, Perla-Navarro AV, Gamez-Nava JI, Gonzalez-Lopez L, Galvan-Villegas F, Ramos-Remus C. Intravenous cyclophosphamide pulses in pyoderma gangrenosum: an open trial. J Rheumatol. 1997;24:689-93.	1997	Mexico	9	Not reported	Three patients with rheumatoid arthritis and two patients with systemic lupus erythematosus	No
82	Chacek et al.¹³⁶136 Chacek S, MacGregor-Gooch J, Halabe-Cherem J, Nellen-Hummel H, Quinones-Galvan A. Pyoderma gangrenosum and extensive caval thrombosis associated with the antiphospholipid syndrome - a case report. Angiology. 1998;49:157-60.	1998	Mexico	1	Ulcerative	Inferior cava vein syndrome due to thrombosis and antiphospholipid syndrome	No
83	Muñiz-Gonzalez et al.¹³⁷137 Muñiz-González A, Kresch-Tronik N, Moreno-Sánchez F, Jáuregui-Camargo L, Halabe-Cherem J, Asz-Sigall D. Dolor abdominal difuso, febricula, náusea, malestar general y dermatosis ulcerativa. Gac Med Mex. 2007;143:427-8.	2007	Mexico	1	Ulcerative	Ulcerative colitis, diverticular disease	No
84	Contreras-Ruiz et al.¹³⁸138 Contreras-Ruiz J, Kresch-Tronik NS, de la Cruz-Garcia MI, Mercado-Ceja S, Lozano-Platonoff A. Delayed diagnosis of pyoderma gangrenosum: a case study. Ostomy Wound Manage. 2008;54:32-6.	2008	Mexico	1	Ulcerative	Rheumatoid arthritis	No
85	Barrera-Vargas et al.¹³⁹139 Barrera-Vargas A, Granados J, Garcia-Hidalgo L, Hinojosa-Azaola A. An unusual presentation of Takayasu's arteritis in two Mexican siblings. Mod Rheumatol. 2015;25:802-5.	2015	Mexico	2	Ulcerative	Two patients with pulmonary nodules and Takayasu's arteritis	No
86	Contreras-Verduzco et al.¹⁴⁰140 Contreras-Verduzco FA, Espinosa-Padilla SE, Orozco-Covarrubias L, Alva-Chaire A, Rojas-Maruri CM, Saez-de-Ocariz M. Pulmonary nodules and nodular scleritis in a teenager with superficial granulomatous pyoderma gangrenosum. Pediatr Dermatol. 2018;35:e35-8.	2018	Mexico	1	Superficial granulomatous	Pulmonary nodules and nodular scleritis	No
87	Real-Delor et al.¹⁴¹141 Real Delor RE, Ramírez Torres L, Rojas G, Britos R, Rojas E, Figueredo N, et al. Pioderma gangrenoso de rápida evolución. Rev Nac (Itauguá). 2011;3:43-5.	2011	Paraguay	1	Bullous	Ulcerative colitis	No
88	Dominguez et al.¹⁴²142 Domiguez L, Aldama O, Rivelli V, Gorostiaga G, Mendoza G, Célias L, et al. Lesiones pustulosas en pacientes con colitis ulcerosa. Dermatol Peru. 2009;19:222-5.	2009	Peru	1	Pustular	Ulcerative colitis	No
89	Carrillo-Nanez et al.¹⁴³143 Carrillo-Ñáñez L, Novoa-Millones L, Carrillo-García PL, Cabrera-Castellano X. Pioderma gangrenoso como presentación inicial de colitis ulcerativa. Rev Soc Peru Med Interna. 2014;27:193-9.	2014	Peru	1	Bullous	Ulcerative colitis	No
90	Deza-Araujo et al.¹⁴⁴144 Deza-Araujo P, Araujo-Castillo M, Rojas-Plasencia P. Pioderma gangrenoso en nino: reporte de caso. Dermatol Peru. 2014;24:262-4.	2014	Peru	1	Ulcerative	Systemic lupus erythematosus	No
91	Fermin et al.¹⁴⁵145 Fermín EY, Rondón LAJ. Pioderma gangrenoso: relevancia clínica Reporte de dos casos. revisión de la literatura. Dermatol Venez. 1989;27:27-30.	1989	Venezuela	2	Ulcerative	One patient with ulcerative colitis	No
92	Valecillos et al.¹⁴⁶146 Valecillos S, Oliver Llull M, Rondón Lugo A, García E, Reyes Jaimes O, Reyes Flores O, et al. Pioderma granulomatoso superficial recalcitrante y embarazo: presentación de un caso y revisión de la literatura. Dermatol Venez. 1998;36:68-72.	1998	Venezuela	1	Superficial granulomatous	Pregnancy	No

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[1] * Corresponding author. E-mail:ortegalo@ohsu.edu (A.G. Ortega-Loayza).