Pyoderma Gangrenosum: A Nightmare for Breast Surgery-Two Case Reports

Abstract

Pyoderma gangrenosum (PG) is a rare, chronic, neutrophilic dermatosis characterized by painful ulcers that are often misdiagnosed as wound infections. We report two cases of postsurgical PG following breast surgery: A 46-year-old woman with a non-healing ulcer after a breast biopsy and a 37-year-old woman with wound dehiscence after bilateral reduction mammoplasty. Both cases were initially managed with repeated debridements, antibiotics, and wound care without improvement. The diagnosis of PG was made based on the increase in wound size and irregularity. Treatment with oral doxycycline and topical tacrolimus led to favorable healing within four months. Breast surgical tehniques, which aim to achieve aesthetic results using intraglandular flaps, have become an important part of clinical practice in breast surgery. Early diagnosis and appropriate management are crucial in postsurgical PG to avoid misdiagnosis and ineffective treatments that cause patient disfigurement.

Keywords: Pyoderma gangrenosum; breast surgery; doxycycline; reduction mammoplasty; tacrolimus.

Figure 1

(Figure 1A, 1B, view at presentation-1C) The incision debrided before the patient presented to our center. (Figure 1C) shows the appearance at the time of presentation

Figure 2

The appearance of the incision line after debridements until the diagnosis of pyoderma gangrenosum was made

Figure 3

Treatment stages and healing process progressing to epithelisation

Figure 4

Histopathological examination of the ulcer edge of patient; focal erosion, non-specific chronic inflammation in the upper-middle and deep dermis, marked increase in fibroblastic activity (X10, H&E) H&E: Hematoxylin and eosin

Figure 5

Stages of treatment, use of bioactive wound dressing and healing process progressing to epithelisation

Figure 6

The stage where epithelisation is achieved and treatment is terminated