Diagnosis of Pyoderma Gangrenosum

Pyoderma Gangrenosum Diagnosis: Book Excerpts

• Ask the Following Questions - GANGRENE

Diagnostic Tests for Pyoderma Gangrenosum: Online Medical Books

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GANGRENE: Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)

1. Does it involve the upper or lower extremity? Involvement of the upper extremities should suggest Raynaud's disease, scleroderma, and other collagen diseases.
2. Are there good peripheral pulses? The complete absence of a peripheral pulse, particularly if it is sudden onset, should suggest an arterial embolism. If it is gradual onset, suspect arteriosclerosis or diabetic ulcer.
3. Are there signs of systemic disease? If there are other signs of systemic disease, collagen disease, macroglobulinemia, and cryoglobulinemia should be suspected.
4. Is the gangrene sudden in onset? A sudden onset of the gangrene should make one suspect clostridia infections or arterial embolism.
5. Is there a positive culture? The culture will be positive in clostridia infections, anthrax, and cancrum oris.

DIAGNOSTIC WORKUP

Routine orders include a CBC, sedimentation rate, chemistry panel, VDRL test, serum protein electrophoresis, ANA titer, and glucose tolerance test. The gangrenous area should be cultured. Plain x-rays of the area sometimes are helpful. If there are diminished pulses, especially if the onset is acute, angiography will be useful. A muscle biopsy or skin biopsy will be useful in diagnosing collagen diseases. The Sia water test and serum immunoelectrophoresis will be useful in diagnosing macroglobulinemia and cryoglobulinemia.

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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003

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