# Pyoderma Gangrenosum: A Presenting Feature of Rheumatoid Arthritis

## TL;DR

A rare skin condition called pyoderma gangrenosum can be the first sign of rheumatoid arthritis, which may often go undiagnosed.

## Contribution

This case report highlights pyoderma gangrenosum as a potential early indicator of rheumatoid arthritis.

## Key findings

- A 65-year-old woman with pyoderma gangrenosum was found to have rheumatoid arthritis through diagnostic testing.
- The skin ulcers were linked to rheumatoid arthritis, suggesting RA may be overlooked in similar cases.
- Pyoderma gangrenosum may serve as a presenting feature of rheumatoid arthritis in clinical practice.

## Abstract

Pyoderma gangrenosum (PG) is an uncommon inflammatory disorder that exhibits a range of clinical manifestations and levels of severity. It frequently occurs alongside an underlying condition, most often inflammatory bowel disease. PG, Sweet syndrome, palisaded neutrophilic granulomatous dermatitis (PNGD), interstitial granulomatous dermatitis (IGD) and rheumatoid neutrophilic dermatitis may be associated with rheumatoid arthritis (RA).

We present a case of a 65-year-old woman with disseminated dermatosis to the hands, abdomen, buttocks, and lower limbs. The dermatosis presented with numerous ulcers of varying shapes, featuring clean bases, undermined edges, and a purplish erythematous appearance. Further investigations, including imaging studies and RA factor and anti-cyclic citrullinated peptide (anti-CCP) levels, led us to the diagnosis of RA.

This case indicates that RA may be frequently undiagnosed and untreated in other patients with PG, as ulcers on the lower extremities can often be the main reason for seeking medical attention.