Pyoderma Gangrenosum After Hand Surgery: A Case Report

Turkhan Mehdiyev, MD; Robert Zimmermann, MD

Disclosures

Wounds. 2021;33(2):E14-E16. 

In This Article

Abstract and Introduction

Abstract

Introduction: Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis that can be triggered after minor trauma or surgery and mimics a fulminating infection. It is commonly associated with a systemic disease, such as inflammatory bowel disease, metabolic syndrome, rheumatologic or hematological disorders, and malignancies. The typical clinical appearance is hemorrhagic nodules, which rapidly progress into extremely painful, irregular, red to violaceous ulceration with undermined border and purulent necrotic bases. The treatment of PG is nonsurgical. Unnecessary surgical procedures may incite a pathergic response, worsening the disease dramatically and potentially resulting in a limb amputation.

Case Report: A report of PG, originally misdiagnosed as an infection after a carpal tunnel release, is presented.

Conclusions: This case emphasizes the importance of early recognition of PG to provide a timely diagnosis and avoid unnecessary surgeries, which can result in devastating consequences.

Introduction

Pyoderma gangrenosum (PG) is a reactive, noninfectious, neutrophilic dermatosis of unknown origin. Pyoderma gangrenosum is a rare disease with an incidence of approximately 0.63 per 100 000 and a median age at presentation of 59 years.[1] In up to 70% of cases, PG occurs in association with a systemic disease, most commonly inflammatory bowel disease, metabolic syndrome, rheumatologic or hematological disorders, or malignancies.[2] The clinical presentation is characterized by hemorrhagic nodules that develop either spontaneously or after trauma and rapidly progress into extremely painful, irregular, red to violaceous ulceration with undermined border and purulent necrotic bases. The diagnosis is made on the basis of clinical findings and medical history as there are currently no definitive laboratory or histopathological criteria for PG.[3] On average, postsurgical PG appears 7 days after surgery at the surgical incision site and is an important differential diagnosis in infections following surgery.[4]

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....