A rare case report of pyodermatitis vegetans linked with inflammatory bowel disease in juvenile population

Abstract

Pyodermatitis vegetans (PDV) is a rare, chronic inflammatory dermatosis associated with inflammatory bowel disease (IBD), particularly ulcerative colitis. Though PDV has been documented globally, it remains rare in pediatric populations and under-reported in Pakistan. This case highlights an adolescent male with suspected IBD presenting with extensive cutaneous manifestations consistent with PDV. A 17-year-old male presented with a 10-year history of recurrent vegetative skin lesions, which initially started behind the left ear and then involved the face, axillae, back, chest, buttocks, gluteal cleft, and genitals. He also reported red, itchy, ring-like lesions on the limbs with systemic complaints, including nausea, anorexia, constipation, painful defecation, and fresh rectal bleeding. Physical examination revealed multiple verrucous plaques, nodular eruptions, crusted lesions, and acne scars. Blood workup showed microcytic hypochromic anemia and elevated serum IgE (1375 IU/mL). Histopathological examination of the skin biopsy shows features diagnostic of PDV, including hyperkeratosis, parakeratosis, follicular plugging, elongation of rete ridges, and dermal fibrosis with lymphocytic infiltration. Considering the clinical features and laboratory findings, the final diagnosis made is pyodermatitis vegetans. This study emphasizes how crucial it is to treat PDV as an uncommon extraintestinal sign of IBD in teenagers who exhibit persistent vegetative skin lesions. Accurate diagnosis, mimicking exclusion, and prompt therapy intervention to address underlying systemic connections all depend on multidisciplinary collaboration and teamwork.