Pyoderma Gangrenosum after Cardiac Surgery.

BACKGROUND: Pyoderma gangrenosum after cardiac surgery is a rare, noninfectious ulcerating skin disease mimicking sternal wound infection. METHODS: A systematic search of literature for pyoderma gangrenosum complicating cases of cardiac surgery was conducted between September 1985 and September 2020 on PubMed and Cochrane databases. A systematic review and detailed overview of clinical presentation, diagnostic, treatment, and outcome is provided. RESULTS: A total of 15 studies enclosing 15 patients suffering from pyoderma gangrenosum following cardiac surgery were identified. Onset of symptoms was observed after a median of 5 days. Patients were predominantly male (81.3%) with a median age of 64 years. Typical clinical presentation mimicked sternal site infection, mainly by means of mediastinitis. Specific signs were rapid progression, erythematous to violaceous color of the wound border, accompanied by unspecific symptoms including fever, malaise, and severe pain. Additionally, pathergy (development of ulcers at the sites of minor cutaneous trauma) was reported frequently. Biopsy is mandatory with a cutaneous neutrophilic inflammation confirming the diagnosis. Initial treatment mostly (75.0% of reported cases) was misled, addressing suspicion of surgical site infection. After correct diagnosis, the treatment was switched to an immunosuppressive therapy. Full sternal wound closure took between 5 weeks and 5 months. Reported case mortality was 12.5% in actually low-risk surgeries. CONCLUSION: Despite pyoderma gangrenosum has typical signs, it remains an exclusion diagnosis. The treatment is completely opposite to the main differential diagnosis-the typical surgical site infection. Knowledge about diagnosis and treatment is essential in the context of avoiding fatal mistreatment.

Peristomal Pyoderma Gangrenosum in a Rectal Cancer Patient With an Ileostomy: A Case Study.

BACKGROUND: Peristomal pyoderma gangrenosum (PPG) is a rare complication mainly associated with inflammatory bowel disease. Although it has also been found in patients with an ileostomy with rectal cancer, the best treatment options in this context have not been precisely elucidated. CASE: This case report describes the importance of a multidisciplinary treatment approach for a rare case of PPG around a protective ileostomy resulting from rectal cancer. CONCLUSIONS: Early diagnosis of PPG is imperative to avoid further extension of the lesion. Aggressive management with a multidrug treatment, both topical and systemic, is recommended in severe cases. Close monitoring of the response is necessary, given the variability in the effectiveness of the treatments.

Efficacy and safety of etanercept for postoperative pyoderma gangrenosum after infliximab serum sickness.

Non-peristomal postoperative pyoderma gangrenosum (PPG) is a rare subtype of pyoderma gangrenosum that occurs in the early postoperative period at surgical incisions, most commonly after breast surgery. Early diagnosis and treatment is essential to prevent severe scaring. TNF-alpha inhibitor infliximab was reported to be efficient in treatment of PPG refractory to systemic corticosteroids. However infliximab can be not well tolerated. We report the first case of etanercept efficacy in post-plastic breast surgery pyoderma gangrenosum after infliximab serum sickness.

Unusual cause of breast wound: postoperative pyoderma gangrenosum.

Postoperative pyoderma gangrenosum (PPG) is an unusual clinical entity, which shows rapidly progressive skin necrosis that can occur within surgical sites after any surgical procedure. Usually, it is diagnosed as wound infection at the time of presentation, but antibiotic therapy and wound debridement fail to arrest rapid ulcer enlargement. We report the case of PPG in a 21-year-old woman after a reduction mammoplasty surgery. In this report, we emphasise the importance of considering pyoderma gangrenosum (PG) as one of the differential diagnoses of breast ulcers after surgical procedures. Careful clinical assessment may establish an early diagnosis and prevent potential serious complications.

[Pyoderma Gangrenosum Mimicking Necrotising Fasciitis after Rotator Cuff Reconstruction]. / Gangrenózní pyodermie po rekonstrukci rotátorové manzety ramena pripomínající nekrotizující fasciitidu.

UNLABELLED: Gangrenous pyoderma is a rare complication of surgical treatment mimicking bacterial necrotizing fasciitis. The characteristic symptoms include a pre-existing immune disorder, negative results of the relevant microbiological examinations, no response to any antibiotic therapy, and deteriorating of the condition after radical debridement. Another typical feature is a discrepancy between an ominous appearance of the wound accompanied by leucocytosis and an elevated CRP level, and the patient s good general condition with low-grade fever and no signs of sepsis. The case of a 68-year-old man who underwent an elective open reconstruction of rotator cuff tears of the left shoulder is presented. The surgery was complicated with pyoderma gangrenosum that was first treated unsuccessfully by repeated revision surgery and broad-spectrum antibiotic therapy. The patient was ultimately cured with corticosteroids. The sequellae included limited motion of the shoulder joint and extensive destruction and scarring of the adjacent soft tissue. KEY WORDS: gangrenous pyoderma, necrotizing fasciitis, corticosteroids.

Recurrent pyoderma gangrenosum after cesarean delivery successfully treated with vacuum-assisted closure and split thickness skin graft: a case report.

We describe the case of a 32-year-old woman (gravidity: 4; parity: 2) who underwent cesarean delivery at 37 weeks of gestation and presented with dehiscence and infection of the surgical wound. She had a history of wound infection and dehiscence of the scar from a previous cesarean delivery and dehiscence in the dorsal side of her left hand at the site of intravenous catheterization. The patient was initially diagnosed with a skin infection and later with pyoderma gangrenosum. No evidence of any underlying disease was found. The lesions were treated with systemic corticosteroids and azathioprine, but the lesions were unresponsive to treatment. This complicated case of pyoderma gangrenosum after cesarean delivery, which initially mimicked wound infection, was successfully treated with vacuum-assisted closure and split-thickness skin graft. This synergistic approach with vacuum-assisted closure could be an important treatment option for aggressive and slow-healing lesions.

[Pyoderma gangrenosum revealing colonic diverticulitis: Two cases]. / Pyoderma gangrenosum révélant une diverticulite colique: deux cas.

BACKGROUND: The association of pyoderma gangrenosum (PG) with colonic diverticulitis infection (DI) is relatively unknown. Herein, we describe two cases of PG with full recovery after colonic surgery. PATIENTS AND METHODS: Case 1: an 83-year-old man presented with lesions on his legs that had been present for several weeks, and a diagnosis of PG was confirmed histologically. Abdominopelvic computed tomography (CT) performed on account of biological inflammatory syndrome revealed DI complicated by abscesses. Following the failure of two different antibiotic regimens, sigmoidectomy was performed. Postoperatively, the skin lesions healed without local or systemic corticosteroids. Case 2: a 63-year-old woman presented PG resistant to local and systemic corticosteroids and dapsone for several months. A particularly severe flare was accompanied by abdominal pain and inflammatory syndrome. CT revealed perforated sigmoid DI. Sigmoidectomy was performed after failure of drug therapy. The patient's PG subsequently improved and had disappeared without recurrence at 24months. DISCUSSION: Both of these cases of PG revealed DI. The hypothesis is that DI constituted a source of colonic inflammation, sending out bacterial antigenic stimuli that resulted in PG through deposition of circulating immune complexes. Removal of this inflammatory source appears to have enabled healing of PG. CONCLUSION: DI must be added to the list of systemic diseases associated with PG. In the case of isolated PG, CT may be used to detect asymptomatic DI. Early diagnosis could prevent serious gastrointestinal complications.

Pyoderma gangrenosum occurring at the peri-ileal pouch-anal anastomosis in a patient with ulcerative colitis: report of a case.

Pyoderma gangrenosum (PG) is an idiopathic, inflammatory, ulcerative skin disorder; the etiology and pathogenesis of which are still poorly understood. It is one of the most important extraintestinal manifestations that can appear in the course of ulcerative colitis (UC). Although skin ulcers with destructive and necrotizing components are more commonly observed on the lower extremities and trunk, PG at stomal sites (peri-stomal PG) has been increasingly reported in patients with inflammatory bowel diseases (IBDs), including UC. Although PG at various surgical sites has been reported as an unusual presentation of PG, postoperative PG developing at the ileal pouch-anal anastomosis (IPAA) has not been reported previously. We herein report the first published case of a patient with UC who developed peri-anastomotic PG after IPAA during the postoperative tapering of systemic corticosteroids.

Pyoderma gangrenosum following breast reduction: treatment with topical tacrolimus and steroids.

UNLABELLED: Pyoderma gangrenosum (PG) is a rare, noninfectious, inflammatory dermatosis usually associated with autoimmune disorders. Wounds may mimic a necrotizing infection, and the diagnosis is usually made after antibiotic therapy fails. Debridement may cause even larger wounds because of pathergy, so PG treatment consists of corticosteroids and local wound care. Pyoderma gangrenosum can be a devastating complication of breast and aesthetic surgery. We describe a case of PG following unilateral breast reduction that resulted in systemic inflammatory response; after treatment with prednisone and topical tacrolimus, the PG was resolved. The application of topical tacrolimus may reduce the need for prolonged corticosteroids. LEVEL OF EVIDENCE: 5.

Pyoderma gangrenosum--a postoperative "pseudo-infection".

Pyoderma gangrenosum is a skin ulcerative necrosis, due to dermal neutrophilic infiltration, through a non-infectious exacerbation of cell -mediated immunity. Being characterized by pathergy, the disease may be triggered by surgery; in this case, it is easily mistaken for a postoperative infection. We report a case of pyoderma gangrenosum after coronary artery bypass surgery. The patient developed, from the 7th postoperative day, around the incisions, dermo-epidermic lesions specific for the disease, high fever with chills and a severe biological inflammatory syndrome. Treatment for wound sepsis was ineffective. After pyoderma gangrenosum was recognized, corticosteroids (Prednisone 80 mg/d) led, in two days time, to a spectacular improvement, and in 7 weeks, to complete epithelization of the lesions. If after debridement of a supposedly infected wound (with pustules, bullae or ulcerations), there is no improvement, but a centrifugal extension of the lesions, with a "sepsis-like" syndrome and persistent negative cultures, one should think at pyoderma gangrenosum; in that case, not the antibiotics, but corticosteroids (or other immunosuppressants) are the treatment.

Beclometasone inhaler used to treat pyoderma gangrenosum.

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis, often associated with underlying systemic disease. We report the use of a corticosteroid inhaler to successfully treat peristomal PG.

Treatment of refractory pyoderma gangrenosum with intravenous immunoglobulin.

We report a patient with pyoderma gangrenosum successfully treated with intravenous immunoglobulin. He had previously been treated for 4 years with high-dose corticosteroids and had developed insulin-dependent diabetes mellitus. Multiple corticosteroid-sparing agents had failed or were contraindicated. He developed no adverse effects from intravenous immunoglobulin, which allowed reduction of his prednisone to 3 mg/day, and his ulcer has completely healed.