Delayed diagnosis of post-surgical pyoderma gangrenosum: A multicenter case series and review of literature

Abstract

Introduction: Pyoderma gangrenosum is a chronic neutrophilic dermatosis which can occur following trauma or surgery and can mimic infection. Surgical intervention can lead to progression of disease.

Presentation of cases: This case series describes 3 cases of post-surgical pyoderma gangrenosum with delayed diagnosis from two large medical centers.

Discussion: Epidemiology, pathogenesis, clinical and histopathologic presentation, and management of post-surgical pyoderma gangrenosum are discussed with a review of the literature.

Conclusion: Post-surgical pyoderma gangrenosum (PSPG) can mimic ulcerative disorders including bacterial infection. The diagnosis should be suspected in post-operative wounds with negative bacterial cultures which progress despite broad-spectrum antibiotics and surgical debridement. Recognizing the clinical features of PSPG is fundamental to prevent severe destruction and deformity.

Keywords: Case report; Necrotizing fasciitis; Post-surgical; Pyoderma gangrenosum.

Fig. 1

Case 1. A: Ulceration shows violaceous undermined border B: Ulceration at site of venipuncture C: Histopathology at low magnification shows superficial and deep suppurative inflammation extending to deep subcutaneous tissue D: Histopathology at high magnification shows abundant neutrophils.

Fig. 2

Case 2. A: Ulceration at stump site shows undermined erythematous border and a cribriform base B: Histopathology at low magnification shows superficial and deep suppurative inflammation extending to subcutaneous tissue C: Histopathology at high magnification shows mainly neutrophils and leukocytoclastic vasculitis.

Fig. 3

Case 3. A: Ulceration at previous surgical sites show undermined erythematous ulcers with surrounding violaceous, blue grey erythema B: Histopathology at low magnification shows suppurative inflammation extending into the deep subcutaneous tissue C: Histopathology at high magnification shows sheets of neutrophils with focal necrosis and hemorrhage.