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Editorial
. 2023 Sep;18(3):528-533.
doi: 10.26574/maedica.2023.18.3.528.

Pyoderma Gangrenosum - a Challenging Diagnostic Approach

Ourania Psoma  1   2 , Anna Loli  2 , Georgios Dimos  2 , Ilias Liappis  2 , Dimitrios Giotis  3 , Vasileios Panagiotopoulos  3 , Christos Konstantinidis  3
Affiliations
Editorial

Pyoderma Gangrenosum - a Challenging Diagnostic Approach

Ourania Psoma et al. Maedica (Bucur). 2023 Sep.

Abstract

Pyoderma gangrenosum (PG) is an infrequent, aseptic neutrophilic dermatosis that can be observed in patients with systemic diseases such as inflammatory bowel disease or rheumatic disorders. Due to its rare entity, PG often constitutes a diagnostic enigma, as it simulates other skin disorders. Typically, it is displayed as painful, ulcerative lesions localized to the lower extremities. In our study, we present a case of a 67-year-old woman with recently diagnosed ulcerative colitis who presented with two painful ulcers, one on the left anterior tibia and the other one on the left subclavian area. Initially, their clinical image overlapped with skin abscess. However, taking into account patient's medical history, skin examination, sterile wound cultures and skin biopsy, the diagnosis of PG was established. The patient was completely recovered with high doses of corticosteroids, daily wound changes and surgical intervention involving loose wound edge approximation. In this study, we highlight that clinicians should always be aware of patient's medical history in such cases, in order to early diagnose PG and avoid inaccurate medical approaches which might have an impact on patients' quality of life.

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Figures

FIGURE 1.
FIGURE 1.
Ulcer of the sternum (left sternoclavicular area) upon admission after the initial debridement
FIGURE 2.
FIGURE 2.
Ulcer of the left anterior proximal tibia upon admission after the initial debridement. The exudative wound base is surrounded by an undermined border and peripheral erythema
FIGURE 3.
FIGURE 3.
Ulcer after one week following debridement. Clinical deterioration of the ulcer and exposure of important tissues (distal patellar tendon and periosteum) can be observed
FIGURE 4.
FIGURE 4.
Ulcer after two weeks of corticosteroid therapy and daily wound changes. The peripheral erythema has been resolved
FIGURE 5.
FIGURE 5.
Approximation of skin edges with three loose horizontal mattress size 2.0 nylon sutures
FIGURE 6.
FIGURE 6.
Ulcer after four weeks following the initial treatment
FIGURE 7.
FIGURE 7.
A complete healing of the lesion after six weeks following the initial treatment
See this image and copyright information in PMC

References

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