Delayed diagnosis of post-surgical pyoderma gangrenosum: A multicenter case series and review of literature. (2018)

• Record Type: Journal Article
• Authors: Almukhtar, Rawaa; Armenta, Andrew M.; Martin, Julie; Goodwin, Brandon P.; Vincent, Bethany; Lee, Brain; Dacso, Mara M.
• Is Part Of: International journal of surgery case reports. Volume 44(2018)
• Page Start: 152
• Page End: 156
• Publication Date: 2018
• Subjects: Post-surgical -- Pyoderma gangrenosum -- Necrotizing fasciitis -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2018.02.026
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: PG remains a diagnosis of exclusion and one not often seen by surgical specialties outside of Dermatology. It can mimic many other cutaneous conditions including bacterial infection, vascular occlusive disease and chronic non-healing wounds. Misdiagnosis often leads to mismanagement and aggressive surgical debridement. Recognizing the clinical features of PG and its pathergenic nature while ensuring timely management is fundamental to preventing severe destruction and deformity. 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.