The diagnosis you wish you had never operated on: Pyoderma gangrenosum misdiagnosed as necrotizing fasciitis—a case report

Hradil, Eva; Jeppsson, Charlotte; Hamnerius, Nils; Svensson, Åke

doi:10.1080/17453674.2016.1260403

Cited by 14 publications

(9 citation statements)

References 9 publications

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“…Ten articles were identified by handsearching the reference list of included studies. Finally, 102 17‐118 articles were included in this systematic review (Figure 1). The studies included were 53 case reports, 28 case series, 15 letters, and 6 conference abstracts published between 1930 and 2019.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of skin grafting in treatment of vasculitic ulcer and pyoderma gangrenosum—A systematic review

Morgenstjerne‐Schwenck

Knudsen

Prasad

2020

Wound Repair Regeneration

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Chronic painful ulcers caused by pyoderma gangrenosum (PG) and cutaneous vasculitis remain to be a therapeutic challenge. Skin grafts have been used with success in selected cases but are generally avoided due to the fear of pathergy. The aim of this study was to investigate the safety and efficacy of skin grafting in the treatment of primary vasculitic ulcer (PVU) and PG. MEDLINE, Embase, the Cochrane Library, http://clinicaltrial.gov, and WHO International Clinical Trials Registry Platform (ICTRP) were searched from inception to March 2020. A search for grey literature was conducted in May 2020. We included studies assessing the efficacy and safety of skin grafting in the treatment of PG and PVU. Studies were only included if skin grafting was performed after establishment of PG or PVU diagnosis. A total of 721 articles was identified through the database search of which 92 were included in this study. Ten articles were identified by handsearching the reference list of included studies. Finally, 102 articles describing 212 wounds in 153 patients were included. Complete healing was found in 75.5% of the wounds. The average time to complete was 10.8 weeks (95% CI 6.1‐15.6). The mean donor site healing time was 1.9 weeks (95% CI 0.52‐3.20). Pathergy was reported in 8 (5.2%) patients. One patient had severe infection related to skin grafting. A statistically significant difference in the number of patients receiving preoperative (P = .0079) and postoperative (P = .002) immunosuppressive therapy was found between the groups with complete healing/reduction and no improvement/aggravation. This systematic review finds the current evidence on efficacy and safety of skin grafting in treatment of PG and PVU to be promising but limited to the size and lack of studies superior to case reports and case series. Future placebo‐controlled trials are required to draw a stronger conclusion.

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Section: Resultsmentioning

confidence: 99%

Efficacy and safety of skin grafting in treatment of vasculitic ulcer and pyoderma gangrenosum—A systematic review

Morgenstjerne‐Schwenck

Knudsen

Prasad

2020

Wound Repair Regeneration

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“…However, PG typically manifests in pathergy, exhibits negative wound cultures, demonstrates aggravated symptoms after surgical interventions, and does not respond to antibiotic therapy. In contrast to NF, PG does respond well to immunosuppressive medications 9,10 . It is worth noting that 90% of patients initially receive antibiotic treatment while approximately 73% undergo at least 1 debridement before PG diagnosis is established.…”

Section: Discussionmentioning

confidence: 99%

Postsurgical Pyoderma Gangrenosum After Minimally Invasive Transforaminal Lumbar Interbody Fusion

Varas-Rodríguez,

Cedeño,

Gonzalez-Diaz

et al. 2023

JBJS Case Connector

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Case: A 61-year-old woman with lower back and radicular leg pain underwent minimally invasive spinal fusion at L5-S1. By postoperative day 6, she exhibited erythema, wound dehiscence, and necrotic changes. Although a necrotizing infection was initially suspected, multiple debridements and antibiotic therapy failed to improve her condition. The patient was eventually diagnosed with pyoderma gangrenosum (PG) and was managed with immunosuppressants and extended wound care. Conclusion: PG is a rare dermatosis that is often misdiagnosed, leading to inappropriate treatment, debridements, and additional complications. Prompt identification and multidisciplinary collaboration are key to preventing unnecessary interventions and achieving the best outcomes.

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“…Several cases of NND misdiagnosed as NF have been reported in the dermatologic literature [ 2 , 6 , 18 , 19 ]. A case series involving 54 patients with NND revealed that 94% were initially given a diagnosis of NF [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Necrotizing neutrophilic dermatosis: A diagnostic challenge with a need for multi-disciplinary recognition, a case report

Gowda

Christensen

Polly

et al. 2020

Annals of Medicine and Surgery

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Introduction Necrotizing neutrophilic dermatoses can clinically resemble necrotizing fasciitis and therefore pose a diagnostic and therapeutic challenge. Given their similar presentations, misdiagnosis and inappropriate or delayed treatments are possible. Presentation of case We discuss the case of a woman with acute myeloid leukemia who presented with fevers, chills, cough, and a leg wound. She underwent amputation of her lower extremity after she was presumed to have necrotizing fasciitis; however, symptoms persisted. She was ultimately diagnosed with and treated for necrotizing Sweet's syndrome with notable clinical improvement. Discussion Both, necrotizing neutrophilic dermatoses and necrotizing fasciitis, grossly affect the skin and are associated with rapidly progressing systemic features including fevers, chills, leukocytosis, and elevated inflammatory markers. Recent literature in dermatology addresses these similarities and the appropriate approach to management; however, it is critical that medical and surgical subspecialties have an understanding of necrotizing neutrophilic dermatoses and their clinical presentations, diagnostic approaches, as well as therapeutic interventions. Familiarity with this entity can mitigate the risk of misdiagnosis, morbidity, and mortality. Conclusion With this report, we seek to review the features that are suggestive of and aid in the diagnosis of necrotizing neutrophilic dermatoses to help prevent significant and avoidable morbidity.

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The diagnosis you wish you had never operated on: Pyoderma gangrenosum misdiagnosed as necrotizing fasciitis—a case report

Cited by 14 publications

References 9 publications

Efficacy and safety of skin grafting in treatment of vasculitic ulcer and pyoderma gangrenosum—A systematic review

Efficacy and safety of skin grafting in treatment of vasculitic ulcer and pyoderma gangrenosum—A systematic review

Postsurgical Pyoderma Gangrenosum After Minimally Invasive Transforaminal Lumbar Interbody Fusion

Necrotizing neutrophilic dermatosis: A diagnostic challenge with a need for multi-disciplinary recognition, a case report

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