Pyoderma Gangrenosum Simulating Necrotizing Fasciitis

Abstract

Pyoderma gangrenosum received this name due to the notion that this disease was related to infections caused by bacteria in the genus Streptococcus. In contrast to this initial assumption, today the disease is thought to have an autoimmune origin. Necrotizing fasciitis was first mentioned around the fifth century AD, being referred to as a complication of erysipelas. It is a disease characterized by severe, rapidly progressing soft tissue infection, which causes necrosis of the subcutaneous tissue and the fascia. On the third day of hospitalization after antecubital venipuncture, a 59-year-old woman presented an erythematous and painful pustular lesion that quickly evolved into extensive ulceration circumvented by an erythematous halo and accompanied by toxemia. One of the proposed etiologies was necrotizing fasciitis. The microbiological results were all negative, while the histopathological analysis showed epidermal necrosis and inflammatory infiltrate composed predominantly of dermal neutrophils. Pyoderma gangrenosum was considered as a diagnosis. After 30 days, the patient was discharged with oral prednisone (60 mg/day), and the patient had complete healing of the initial injury in less than two months. This case was an unexpected event in the course of the hospitalization which was diagnosed as pyoderma gangrenosum associated with myelodysplastic syndrome.

Pyoderma gangrenosum misdiagnosed as necrotising fasciitis or a real association between the two?

“…1-5 Inappropriate shorthand in documentation may potentially be corrected with increasing experience. 1 The survey by Vale et al corroborates our finding that nondermatologists have difficulty understanding dermatology-specific shorthand. Illustratively, most of our survey respondents reported that they had received a consult note in the last 6 months where they were unable to understand the diagnosis and management plan due to abbreviations.…”

“…Distinguishing between pyoderma gangrenosum (PG) and necrotising fasciitis (NF) can be challenging in certain cases because the treatments are very different. 1 We report a case that led us to consider the differential diagnosis of both conditions, and also their association.…”

“…Effective communication is vital for safe and comprehensive patient care; however, specialty-specific abbreviations pose a communication challenge between multidisciplinary teams. 1 Dermatology is guilty of acronymophilia. 2 We conducted a survey of primary care providers (PCPs) to determine the understanding of abbreviations commonly used in our dermatology department.…”

Pyoderma Gangrenosum Masquerading as Necrotizing Fasciitis: Stepping Away from Cognitive Shortcuts

“…Pyoderma gangrenosum is a skin condition characterized by intense inflammation, which can certainly be mistaken for infection. It is a rare and often recurring chronic neutrophilic dermatosis, which predominantly occurs on the lower extremities in patients with inflammatory and haematological disorders [1] . Originally thought to be caused by bacteria of the genus Streptococcus , PG is now considered an autoimmune disease.…”

Periokuläre nekrotisierende Fasziitis – Fallbericht und Überblick

“…B. Colitis ulcerosa einher. Kleine Pusteln entwickeln sich zu tiefen Ulzera mit lividen erhabenen Rändern, wobei die Erkrankung deutlich langsamer fortschreitet als die nekrotisierende Fasziitis [6,11]. Eine chirurgische Behandlung ist kontraindiziert, da sie zu einer weiteren Ausbreitung der Erkrankung führen kann (Pathergiephänomen) [22,26].…”