Pyoderma gangrenosum; Surgeons beware...!

Abstract

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Introduction: Pyoderma gangrenosum (PG) is an uncommon, ulcerative cutaneous condition of uncertain aetiology. In up to 50% of patients it’s associated with an underlying systemic disease, ie, inflammatory bowel disease, j;s arthritis or a haematological disease. This neutrophilic dermatosis most frequently affects the lower extremities of I adults aged 25-54 years. PG is a diagnosis of exclusion, other causes of similar cutaneous ulcerations need to be J excluded. PG ulcers demonstrate pathergy, ie, worsening in response to minor trauma or surgical debridement. | Case Report: A 62 year old male, diagnosed with myelodysplastic syndrome (MDS) 3 years ago, presented with a non-healing leg ulcer for more than a year. He had developed a small wound over the area following minor trauma j which had progressively worsened over the past year, leading to an almost circumferential leg ulcer. He had undergone several aggressive surgical wound debridements which had not improved the condition but rather worsened it. The ulcer had undermined, overhanging, dusky purple edges with surrounding induration and erythema. The base of the. ulcer contained necrotic tissue with a purulent exudate^ A diagnosis of PG was made using the criteria described by Su et al, and the patient was started on systemic and topical steroids. The ulcer responded,1 dramatically to this treatment and4s reducing in size and healing well at present. - ! Discussion: It is important to be aware of PG and to suspect it in the relevant patient. Surgical intervention, may sometimes appear tempting, but will simply make the condition worse.