Early Diagnosis of Upper Eyelid Pyoderma Gangrenosum Using the PARACELSUS Score and Tissue-Sparing Management With Adjunctive Hypochlorous Acid Therapy: A Case Report.
Anıl Akdeniz, Görkem Polat, Safiye Aktaş et al.
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Case in brief
A 17-year-old patient with ulcerative colitis developed progressive upper-eyelid ulceration, initially managed as preseptal cellulitis and later considered a possible necrotizing infection. The lesion worsened despite broad-spectrum antibiotics. Sterile cultures, associated skin lesions, clinical findings, and a PARACELSUS score of 17 supported pyoderma gangrenosum (PG), so systemic corticosteroids were started before histopathologic confirmation. Histopathology later confirmed PG. With tissue-sparing wound care, including topical hypochlorous acid and ophthalmic antibiotic ointment, the eyelid completely re-epithelialized within 3 weeks, without malposition, functional sequelae, or recurrence during 8 months of follow-up.
What made this case unusual
The periocular ulceration mimicked both preseptal cellulitis and a necrotizing infection, while worsening on antibiotics; the PARACELSUS score supported treatment for PG before biopsy confirmation.
Diagnostic / clinical pearl
In progressive periocular ulceration that worsens despite antibiotics, sterile cultures and associated skin lesions can support PG; the PARACELSUS score may help guide early diagnosis and treatment before histopathologic confirmation.
Why it matters
Prompt tissue-preserving management in this case was followed by healing without eyelid malposition or functional sequelae.