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. 2018:44:152-156.
doi: 10.1016/j.ijscr.2018.02.026. Epub 2018 Feb 19.

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

Rawaa Almukhtar  1 , Andrew M Armenta  2 , Julie Martin  3 , Brandon P Goodwin  2 , Bethany Vincent  3 , Brain Lee  4 , Mara M Dacso  5
Affiliations

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

Rawaa Almukhtar et al. Int J Surg Case Rep. 2018.

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.

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Figures

Fig. 1
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
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
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.
See this image and copyright information in PMC

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