The road to diagnosis: presentation from erythema nodosum to vegetative pyoderma gangrenosum

We report the rare occurrence of erythema nodosum and pyoderma gangrenosum at different times during the clinical course in a 30-year-old gentleman. He initially presented with biopsyproven erythema nodosum over both shins. He subsequently developed multiple violaceous and vegetative nodules over the upper and lower limbs. Three serial skin biopsies were performed thereafter. A diagnosis of vegetative pyoderma gangrenosum was made based on the clinical findings and histopathological features. He showed good treatment response to oral steroid.