The other variants of PG are less common and usually respond well

The other variants of PG are less common and usually respond well to immunosuppressive treatments exactly [3]. In our study, the lesions were more commonly localised to the lower limbs (56.5%) but this proportion was lower than other studies which reported a proportion of 70% to 80% [3, 12, 13, 15]. Pathergy was a precipitating factor in almost half the cases. One of the main causes of pathergy was surgery. It is therefore critical for clinicians to be aware and vigilant in diagnosing this complication as delayed diagnosis can potentially lead to poorer prognosis.

Many studies have reported that, in 50 to 70% of the cases, PG is associated with an underlying disease such as IBD, inflammatory arthritis, haematological disorders, and solid malignancies [11–15]. In our study, 47.8% of patients had associated systemic diseases. Most patients presented with known systemic disorders. Only one patient was newly diagnosed with an associated systemic disease during the acute admission. He was diagnosed with monoclonal gammopathy on serum protein electrophoresis. This highlights the importance of screening patients with PG for associated systemic diseases. 4.3. Investigations It is not uncommon for PG to occur with wound infection. We observed that

CRP alone is not specific for wound infection [6, 19, 20]. An elevated CRP can indicate either a concomitant bacterial infection or active inflammatory process associated with PG. However, an abnormally high level of CRP more than 50mg/L, a positive wound culture, and clinical signs such as erythema and swelling indicate a wound infection which should prompt treatment with antibiotics. Immunosuppression should still be continued to prevent progression of PG [6, 19, 20] except in the presence of systemic sepsis. CRP is a valuable investigation and has been shown in previous studies to be useful in monitoring progression of PG [11]. Histology findings are nonspecific but can serve to exclude infection, malignancy, and vasculitis [2]. Neutrophilic infiltration into

dermis is the histological hallmark of PG [2] and is consistent with the Brefeldin_A results of our study. Other histological findings of leukocytoclasia, abscess, and vasculitis are also seen in our patients. 4.4. Treatment Systemic therapy is the mainstay of treatment for severe, progressive PG which is commonly seen in patients requiring hospital treatment for PG [7, 8]. Twenty-one patients received systemic therapy. Only two patients with mild PG received topical therapy and were discharged after a relatively short hospital stay. One patient was admitted as she was also suffering from community acquired pneumonia while the other had peristomal PG and required admission to monitor his underlying Crohn’s disease. Systemic corticosteroids have been shown to be effective in a number of studies and are therefore considered as first-line therapy [7, 8].

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