Dermatitis Artefacta with Proteus mirabilis Infection in Coincidence with Pyoderma Gangrenosum in Schizophrenic Patient

Abstract

Dermatitis artefacta (DA) is a psychiatric disorder with secondary manifestations on the skin. One of the most common skin lesions in DA is chronic ulcer which also can be caused by pyoderma gangrenosum (PG). There are some bacteria found in chronic ulcer such as Proteus mirabilis. A forty-one years old female with chronic wounds on her chest and left leg. Based on history taking of present illness, physical examinations, laboratory tests and histopathology of the skin lesions, the patient was diagnosed with DA and PG. She was also diagnosed with schizophrenia catatonic type. Chest x-ray showed pneumonia while the swab culture showed growth of Proteus mirbabilis. She was given an oral cefadroxile 500 mg three times daily, cetirizine 10 mg once daily, wound dressing and gentamycin ointment twice daily. She also received oral risperidone 0.5 mg twice daily combined with behavioral therapy from Psychiatric Outpatientclinic. Dermatitis artefacta is a psychocutaneous disorder with uncommon morphology. The most common psychological condition related to DA is schicophrenia. There are some specific histopathology features of DA such as dominant destruction of epidermal layer, multinucleated epidermal keratinocytes or destruction of keratinocytes. Chronic ulcers in DA might be mimicking with PG, which is a chronic recidive neutrophilic dermatoses. Proteus mirabilis is one of the most common causes of urinary tract infection, meanwhile it can also cause chronic ulcers and respiratory tract infection as pneumonia.