Residents' Corner: Pyoderma Gangrenosum at Surgery Sites

Fulbright, Robert K.; Wolf, John E.; Tschen, Jaime A.

doi:10.1111/j.1524-4725.1985.tb03559.x

Cited by 42 publications

(19 citation statements)

References 41 publications

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“…The development of PG is a feared complication after breast surgery and other surgical procedures [18-20]. It seems to me that areas rich in subcutaneous fat tissue bear a somewhat higher risk than others but systematic investigations in this field are missing.…”

Section: Clinical Presentationmentioning

confidence: 99%

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Pyoderma gangrenosum – a review

Wollina

2007

Orphanet J Rare Dis

230

246

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Pyoderma gangrenosum (PG) is a rare noninfectious neutrophilic dermatosis. Clinically it starts with sterile pustules that rapidly progress and turn into painful ulcers of variable depth and size with undermined violaceous borders. The legs are most commonly affected but other parts of the skin and mucous membranes may also be involved. Course can be mild or malignant, chronic or relapsing with remarkable morbidity. In many cases PG is associated with an underlying disease, most commonly inflammatory bowel disease, rheumatic or haematological disease and malignancy. Diagnosis of PG is based on history of an underlying disease, typical clinical presentation, histopathology, and exclusion of other diseases that would lead to a similar appearance. The peak of incidence occurs between the ages of 20 to 50 years with women being more often affected than men. Aetiology has not been clearly determined yet.The treatment of PG is a challenge. Randomized, double-blinded prospective multicenter trials for PG are not available. The best documented treatments are systemic corticosteroids and ciclosporin A. Combinations of steroids with cytotoxic drugs are used in resistant cases. The combination of steroids with sulfa drugs or immunosuppressants has been used as steroid-sparing modalities. Antitumor necrosis alpha therapy in Crohn's disease showed a rapid response of PG. Skin transplants and the application of bioengineered skin is useful in selected cases as a complement to the immunosuppressive treatment. Topical therapy with modern wound dressings is useful to minimize pain and the risk of secondary infections. Despite recent advances in therapy, the prognosis of PG remains unpredictable.

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Section: Clinical Presentationmentioning

confidence: 99%

“…Fulbright et al . [20] hypothesized that PG results from an aberrant immune response to yet unidentified factors. Depositions of proteins in skin vessels in PG lesions have suggested an Arthus-like reaction [34].…”

Section: Etiology and Pathogenesismentioning

confidence: 99%

Pyoderma gangrenosum – a review

Wollina

2007

Orphanet J Rare Dis

230

246

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“…Topical therapy involves the use of dressings to control exudation, improve auto-debridement, protect the surrounding skin, and provide analgesia 14. Deep wounds may benefit from vacuum sealing as it improves granulation 15. The topical use of antimicrobials is not recommended as they may irritate the ulcers and surrounding skin.…”

Section: Discussionmentioning

confidence: 99%

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

Ye¹,

Ye²,

Wu³

et al. 2014

CCID

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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.

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“…PG in the setting of pathergy can mimic postsurgical wound ulceration or spontaneous dehiscence. 23 At least 16 cases of PG developing in surgical wounds have been reported. 24 PG has been found to occur in surgical scars, parastomal sites, skin grafts, and sites of intravenous catheters, pleural aspiration, and injections.…”

Section: Discussionmentioning

confidence: 99%