Skin Ulcerations in a Lupus Hemodialysis Patient With Hepatitis C Infection What Is Your Diagnosis?

A 47 years old female patient with lupus nephritis on hemodialysis for 18 years presented with an inflammatory lesion that interested the right leg. She was on prednisone, 7.5 mg/d. Dermatological examination showed grouped papular lesions with hemorrhagic content on the front of the right leg. In a few days, large ulcerations appeared with elevated and undetermined borders that gradually expanded. Serology was positive for hepatitis C. Histological examination of the lesion showed a nonspecific diffuse neutrophilic infiltration in the superficial dermis, accompanied by edema and interspersed lymphocytes. These features were consistent with a neutrophilic dermatosis. A diagnosis of pyoderma gangrenosum (PG) was made.