Cocaine-induced pyoderma gangrenosum with negative anti-neutrophil cytoplasmic antibodies: A case report

Cutaneous pyoderma gangrenosum (PG) is an ulcerating autoinflammatory neutrophilic dermatosis often associated with inflammatory bowel disease, hematologic diseases, or arthritis. PG secondary to systemic medications is less commonly reported. PG is a diagnosis of exclusion that requires investigation of other causes of cutaneous ulcers prior to final diagnosis. We herein describe a case of cocaine-induced PG with atypical features (recurrent ulcerations limited to the lower extremities and perinuclear anti-neutrophil cytoplasmic antibody negativity) following years of abstinence from cocaine. PG is a rare autoinflammatory neutrophilic dermatosis and a diagnosis of exclusion because of its nonspecific clinical presentation. Drug-induced PG is less common but presents an opportunity to further research the pathogenesis of PG. This unusual case reinforces that drug-induced PG may have non-classical features and may serve as an indicator of past or present substance abuse, allowing for patient education and counseling.