A challenging diagnosis: case report of extensive pyoderma gangrenosum at multiple sites

Abstract

BackgroundPyoderma gangrenosum (PG) is a rare dermatological condition characterized by the rapid progression of a painful, necrolytic ulcer with an irregular, undermined border and commonly affects the lower extremities, mainly in the pretibial area. The diagnosis of PG is not easy. Due to lack of diagnostic laboratory test and histopathological findings indicative of PG, it is often misdiagnosed as an infection. This results in delayed or inappropriate treatment of the condition, which leads to devastating consequences such as limb amputation and death.Main observationsWe report a rare case of a 51-year-old female who was initially diagnosed as having infected ulcers and underwent serial debridements, which resulted in extensive PG at three different sites (abdominal, left thigh, and sacral).ConclusionThis case highlights the challenges in diagnosing PG, emphasizes the key clinical features to aid diagnosis, and the clinical consequences of delayed or misdiagnosis of this condition.

Pyoderma Gangrenosum: A Review of Clinical Features and Outcomes of 23 Cases Requiring Inpatient Management

“…It is not uncommon for PG to occur with wound infection. We observed that CRP alone is not specific for wound infection [ 6 , 19 , 20 ]. An elevated CRP can indicate either a concomitant bacterial infection or active inflammatory process associated with PG.…”

“…However, an abnormally high level of CRP more than 50 mg/L, a positive wound culture, and clinical signs such as erythema and swelling indicate a wound infection which should prompt treatment with antibiotics. Immunosuppression should still be continued to prevent progression of PG [ 6 , 19 , 20 ] except in the presence of systemic sepsis. CRP is a valuable investigation and has been shown in previous studies to be useful in monitoring progression of PG [ 11 ].…”

“…Surgical intervention can worsen PG through pathergy [ 2 , 19 , 20 ]. Therefore, surgical intervention such as SSG should only be performed in conjunction with immunosuppression.…”

Extensive Pyoderma Gangrenosum: A Challenging Diagnosis and Literature Review of Management

“…In addition to that, two minor criteria must also be met. These include pathergy, rapid response to corticosteroids, underlying systemic diseases like seronegative spondyloarthropathies known to be associated with PG (i.e., inflammatory bowel diseases, hematological malignancies, and arthritis), and histopathology showing neutrophilic infiltrates, with or without lymphocytic vasculitis [ 6 ]. Our patient did meet the above criteria.…”

Disseminierte, therapieresistente Hautulzerationen bei einem 51-jährigen Patienten – Der Fall eines multifokalen Pyoderma gangraenosum

“…Tiefe Wunden können nach Einleitung der Steroidtherapie von einer Behandlung mit Vakuum-Pumpen profitieren. Bei milden Formen kann topisches Tacrolimus Erfolge erzielen [13]. Positive Therapieberichte finden sich in der aktuellen Litaratur zudem über die intraläsionale Applikation von Triamcinolonacetonid und aktiviertem Protein C [11].…”