LAUSR

Dear Editors, A 57 years old Caucasian male, attending the outpatient of University Hospital Federico II of Naples, section of Dermatology, presented to our attention in June 2018 with a painful ulcerated lesion characterised by a peripheral red halo with raised, red-purple, edges and a purulent base on the right side of the trunk (Figure 1). The onset dates back to May 2018. The patient had a history of idiopathic hypertension on therapy with hydrochlorothiazide. His erythrocyte sedimentation rate was 21 mm/h, C-reactive protein was 17 mg/L, white blood cell count was 5.7 × 108/L, and fibrinogen was 3.7 g/L. Other standard parameters were all normal. Pathogenic bacteria were not detected from the tissue or from the ulcer floor. We performed a punch biopsy and histology showed hyperplasia of the epidermis and extensive neutrophilic infiltration in the dermis with focal microabscesses and no signs of vasculitis: these findings confirmed the pyoderma gangrenosum (PG) aspect. All autoimmune markers such as rheumatoid factor, antinuclear antibody, anti-extractable nuclear antigens, and anti-