Pyoderma Gangrenosum of the Eyelid: A Challenging Case.

BACKGROUND Pyoderma gangrenosum (PG) involving the eyelid is rare and can closely mimic other differential diagnoses, posing a diagnostic challenge. This case highlights the diagnostic approach and management of pyoderma gangrenosum-related eyelid lesions. CASE REPORT A 29-year-old man with a history of ulcerative colitis developed a persistent ulcerative lesion on his left upper eyelid, which failed to respond to conventional treatment for chalazion. Examination revealed a pinkish-yellow ulcerative lesion with ill-defined borders, causing distortion of the eyelid margin contour. Due to the potential for malignancy or atypical inflammatory disease, an incisional biopsy was performed. Infectious, rheumatologic, and vasculitis workup results were negative. Histopathological findings were consistent with a diagnosis of eyelid pyoderma gangrenosum. Initial treatment with intralesional triamcinolone resulted in limited improvement. In collaboration with the patient's gastroenterologist, the biologic immunomodulator ustekinumab was administered, leading to a substantial reduction in lesion size. To our knowledge, this represents the first reported case of eyelid pyoderma gangrenosum successfully treated with ustekinumab. At the 3-month follow-up, the eyelid lesion demonstrated considerable improvement. The patient remained stable without recurrences during 1 year of follow-up. CONCLUSIONS Pyoderma gangrenosum is a rare and aggressive condition that should be considered in the differential diagnosis of any ulcerative eyelid lesion. Given the diagnostic difficulty, management should focus on controlling the underlying systemic disease in collaboration with a gastroenterologist. Early diagnosis and appropriate management are crucial to prevent facial disfigurement and the need for complex eyelid reconstruction.