Mortality and Autopsy Findings in Patients with Pyoderma Gangrenosum: A Multi-Institutional Series

Abstract

Introduction: Pyoderma gangrenosum (PG) is a rare ulcerative skin condition with an increased risk of mortality compared to the general population. The causes of this increased risk are not well understood. Misdiagnosis is common in pyoderma gangrenosum, and many studies are limited by the inclusion of misdiagnosed cases. The goal of this study is to review autopsy findings, identify causes of death, and identify factors that may worsen outcomes among deceased patients confirmed to have PG. Methods: Data was retrospectively reviewed from the electronic medical records at five academic hospitals. A search was conducted for deceased patients with a diagnosis of PG who had autopsy performed between 2010 and 2020. We report a descriptive analysis of eleven patients and their clinical characteristics, causes of death, and autopsy findings. Results: The average age of death was 62.9 years. Seven patients had at least one underlying condition known to be associated with PG including inflammatory bowel disease, inflammatory arthritis, or a hematologic disorder. The most common cause of death was infection (n = 6, 54.5%) followed by pulmonary embolism (n = 3, 27.3%) and myelodysplastic syndrome (n = 2, 18.2%). Six patients (54.5%) were taking systemic steroids at the time of death. Conclusion: The development of PG may shorten life expectancy among those with underlying conditions associated with PG, and common treatments for PG may contribute to the risk of fatal complications. Awareness of the risk of infection, thrombosis, and malignancy among those with PG is necessary for proper management. Further research is needed to explore the relationship between pyoderma gangrenosum and thromboembolism.

Drug-Induced and Malignancy-Associated Neutrophilic Dermatoses in Patients with Hematologic Malignancies: A Single Institution Experience

“…While those with cancer are inherently at increased risk for infection, ND may independently further increase the risk given that many patients have open wounds and are treated with systemic corticosteroids. Notably, a recent case series suggested that pyoderma gangrenosum may modify the time to mortality among those with inflammatory bowel disease and rheumatoid arthritis, although the study was unable to comment on hematologic malignancy [17].…”