A biopsy including the border of the ulcer and the adjacent skin is necessary to exclude vasculitis, malignancy and infection. PG is a diagnosis of exclusion as the histopathologic findings are not specific. 4 The pathogenesis of PG remains unclear, but a dysfunction of neutrophil chemotaxis might be involved. In 50% of cases, pyoderma gangrenosum (PG) is associated with neoplasm, illicit drugs, systemic inflammatory diseases (ulcerative colitis, Behcet's disease, Crohn's disease, Wegner's granulomatosis and rheumatoid arthritis) and myeloproliferative diseases. 1Ĭhronic ulcerated lesions affecting the EAC and auricles can be secondary to several diseases, including malignant external otitis, skin infection (fungal, mycobacterial or viral), insect bites, lymphoma, cutaneous primary tumor, metastasis, perichondritis, vasculitis, Wegner's granulomatosis, artifact dermatitis, neurodermatitis and pyoderma gangrenosum. However, recurrent or persistent suppurative otitis media, foreign body, trauma, radiation, tumors are also reported. 2 The most common cause is chronic external otitis. Stenosis of the EAC is rare, with an incidence of 0.6 cases per 100,000 inhabitants. The patient subsequently underwent a left nephrectomy with histological diagnosis of a clear cell variant of renal carcinoma. Inflammatory markers, C3, C4, p-ANCA, c-ANCA and ANA were normal.Īn isodense mass was observed in an abdominal CT, located in the middle third of the left kidney, heterogeneous, with peripheral contrast uptake of 6 cm × 6.4 cm × 6 cm ( Fig. Multisensible Acinetobacter baumani was isolated in the culture. Histopathologic examination revealed nonspecific chronic inflammation affecting the dermis and the perichondrium with focal ulceration of the skin, suggestive of pyoderma gangrenosum ( Fig. The patient was discharged after 21 days with antibiotic therapy (Ciprofloxacin 750 mg, 21 days) and office follow-up for possible surgery for stenosis correction.Īfter 3 months, the patient presented with severe bilateral otalgia associated with otorrhea, and necrosis of the auricular concha, tragus and intertragic incisure bilaterally. The lesion improved after two weeks, evolving to scar stenosis of the EAC. Due to the possibility of malignant external otitis, the patient was treated with Piperacillin and Tazobactam for 21 days. 1A) showed obliteration of the EAC without regional bone involvement. Otoscopy revealed an ulcerated lesion in the auricle and edema of the EAC, preventing appropriate visibilization of the tympanic membrane.Ĭomputed tomography (CT) of the temporal bones ( Fig. Male, 56, presenting with an ulceration on the right auricular concha for 45 days, with poor response to topical and systemic antibiotics, associated with otorrhea, hearing loss, otalgia and fever. This is the first report of auricular pyoderma gangrenosum manifesting as paraneoplastic syndrome of renal clear cell carcinoma, evolving to stenosis of the EAC. However, no reports exist of acquired stenosis of EAC secondary to paraneoplastic syndrome. Acquired stenosis of the external auditory canal (EAC) is uncommon, 1 with several related causes.
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