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Champigny M, Toomey A, Sherbert D. Pyoderma Gangrenosum Presentation After Abdominoplasty and Augmentation Mastopexy. Cureus 2024; 16:e58060. [PMID: 38738036 PMCID: PMC11088448 DOI: 10.7759/cureus.58060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
Pyoderma gangrenosum is a rare ulcerative skin disease of uncertain etiology, which in some cases can be misdiagnosed as an infectious process. In even more unique cases, this can occur in the postoperative period. Termed postsurgical pyoderma gangrenosum, this type of inflammatory skin condition requires a high index of suspicion to be able to appropriately treat and reduce complications. We present a 55-year-old female who presented with multiple wounds following mastopexy and abdominoplasty. With a prompt diagnosis and a multidisciplinary approach, we could accurately care for the patient and minimize poor aesthetic sequela.
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Affiliation(s)
- Michele Champigny
- Plastic and Reconstructive Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Ariel Toomey
- Plastic and Reconstructive Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Daniel Sherbert
- Plastic and Reconstructive Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, USA
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Keramidas E, Rodopoulou S, Avgerinos N. Early Diagnosis and Treatment of Pyoderma Gangrenosum: Reviewing Mobile Phone Photos Saved a Patient From Unnecessary Surgeries. Cureus 2024; 16:e54797. [PMID: 38405660 PMCID: PMC10893982 DOI: 10.7759/cureus.54797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 02/27/2024] Open
Abstract
Pyoderma gangrenosum of the breast following surgery is a rare aseptic inflammatory cutaneous condition that causes very rapid progressing and expanding painful ulceration of the surgical site and the adjacent skin. The greatest issue concerning pyoderma gangrenosum is its diagnosis. Almost invariably, it is misdiagnosed as a wound infection, which results in delayed identification, lengthy antibiotic regimens, and ineffective detrimental surgical debridements, causing significant patient disfigurement. We present a rare case report of pyoderma gangrenosum complicating the surgical site of the breast reduction procedure two months after simultaneous performance of operations including breast reduction, abdominoplasty, and lumbar liposuction. The diagnosis was established within four hours from the initial lesion and symptom presentation due to the accurate evaluation of photographs sent from the patient's mobile phone to the surgeon every half hour. Immediate appropriate treatment with oral corticosteroids within this time interval was initiated, resulting in favorable healing for the patient within four months.
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Edek YC, Temirkaynak MK, Temel B, Urgancı M, Öğüt B, Adışen E. Postoperative Pyoderma Gangrenosum Following Carpal Tunnel Surgery: A Case Report and Review of the Literature. Cureus 2024; 16:e54590. [PMID: 38523971 PMCID: PMC10959458 DOI: 10.7759/cureus.54590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by painful ulcerated lesions. Postoperative PG, which typically begins with erythema and severe pain within two weeks after surgery, progresses into ulcerated lesions. It is often misdiagnosed as it resembles necrotizing skin infections, resulting in delayed treatment. Cases of postoperative PG located in the upper extremity are uncommon. In this case report, we discuss a male patient who developed postoperative PG after carpal tunnel surgery.
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Affiliation(s)
| | | | - Berkay Temel
- Dermatology, Ankara Training and Research Hospital, Ministry of Health, Ankara, TUR
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Baco SJ, Mišić J, Peruničić V. Postoperative Pyoderma Gangrenosum (PPG) After Appendectomy: A Case Report. Cureus 2023; 15:e42016. [PMID: 37469578 PMCID: PMC10353335 DOI: 10.7759/cureus.42016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 07/21/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a rare, poorly understood, non-infectious, autoimmune phenomenon. It is an inflammatory neutrophilic dermatosis characterized by hyperactivity of the skin and the development of papules and pustules that rapidly progress to painful ulcerations with a violaceous and necrotic border. Approximately three to six cases of PG per million of the population occur per year and in the case of postoperative pyoderma gangrenosum (PPG), it is only one to three cases per million operated people. We are presenting a 41-year-old patient with a clinical presentation of PPG, developed in the surgical site on the sixth postoperative day (POD 6) following open appendectomy for acute appendicitis. Initial treatment was for surgical site infection (SSI) with wound opening, regular dressings, and broad-spectrum antibiotics. Due to unresponsiveness to therapy and the unexpected postoperative course with the progression of skin lesions, we suspected PPG. Corticosteroid therapy was introduced in a shock dose, once daily intravenous (IV), with superb results and stopping the spread of the process after only two days. Considering the rarity of PPG, especially when it first occurs postoperatively, we believe that the image of skin changes with superficial spreading and characteristic violaceous ulcerations can be of crucial importance for early diagnosis. A multidisciplinary approach with a mandatory examination by a dermatologist is important in order to make an early diagnosis and prevent wrong treatment, with the potential worsening of the patient's condition. Atraumatic wound care and negative pressure wound therapy are recommended. Patients at risk should perioperatively receive corticosteroids and postoperatively be closely observed for the potential development of PPG. Debridement is not recommended, and surgical treatment and further tissue trauma are undesirable and even prohibited.
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Affiliation(s)
- Stanko J Baco
- Department of General Surgery, Public Health Institution Hospital "Dr Mladen Stojanovic", Prijedor, BIH
| | - Jovica Mišić
- Department of General Surgery, Saint Luke the Apostle Hospital, Doboj, BIH
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Wanner B, Saridakis S, Sammons D. Consecutive Cases of Pyoderma Gangrenosum Following Dermatologic Surgery. J Clin Aesthet Dermatol 2020; 13:49-50. [PMID: 33178383 PMCID: PMC7595358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare ulcerative skin disease commonly associated with pathergy and systemic comorbidities. We present the case of a patient who experienced two episodes of PG following consecutive dermatologic surgeries to the left hand. The initial PG ulcerations occurred simultaneously following Mohs surgery and a standard elliptical excision. Five months later, her PG recurred after Mohs surgery. Our patient denied a history of PG, however, further questioning elicited a medical history significant for Crohn's disease. Dermatologists and Mohs surgeons should consider the diagnosis when evaluating patients with poor postoperative wound healing. Unfortunately, a delay in diagnosis often occurs, as the presentation of postsurgical PG can mimic other common skin conditions. Awareness of PG prior to dermatologic surgery is critical to prevent further postoperative complications and unnecessary debridement.
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Affiliation(s)
- Brian Wanner
- Dr. Wanner is a dermatology resident, PGY-3, at OhioHealth Riverside Methodist Hospital in Columbus, Ohio
- Dr. Saridakis is an intern, PGY-1, at OhioHealth Riverside Methodist Hospital in Columbus, Ohio
- Dr. Sammons is Dermatology Residency Program Director at OhioHealth Riverside Methodist Hospital in Columbus, Ohio
| | - Stephanie Saridakis
- Dr. Wanner is a dermatology resident, PGY-3, at OhioHealth Riverside Methodist Hospital in Columbus, Ohio
- Dr. Saridakis is an intern, PGY-1, at OhioHealth Riverside Methodist Hospital in Columbus, Ohio
- Dr. Sammons is Dermatology Residency Program Director at OhioHealth Riverside Methodist Hospital in Columbus, Ohio
| | - Dawn Sammons
- Dr. Wanner is a dermatology resident, PGY-3, at OhioHealth Riverside Methodist Hospital in Columbus, Ohio
- Dr. Saridakis is an intern, PGY-1, at OhioHealth Riverside Methodist Hospital in Columbus, Ohio
- Dr. Sammons is Dermatology Residency Program Director at OhioHealth Riverside Methodist Hospital in Columbus, Ohio
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Ariane M, Bouaziz JD, de Masson A, Jachiet M, Bagot M, Lepelletier C. Efficacy and safety of etanercept for postoperative pyoderma gangrenosum after infliximab serum sickness. Dermatol Ther 2018; 32:e12774. [PMID: 30341800 DOI: 10.1111/dth.12774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/19/2018] [Accepted: 10/06/2018] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Molka Ariane
- Assistance Publique- Hôpitaux de Paris, Département de Dermatologie, Hôpital Saint-Louis, Paris, France
| | - Jean-David Bouaziz
- Assistance Publique- Hôpitaux de Paris, Département de Dermatologie, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | - Adèle de Masson
- Assistance Publique- Hôpitaux de Paris, Département de Dermatologie, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | - Marie Jachiet
- Assistance Publique- Hôpitaux de Paris, Département de Dermatologie, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | - Martine Bagot
- Assistance Publique- Hôpitaux de Paris, Département de Dermatologie, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | - Clémence Lepelletier
- Assistance Publique- Hôpitaux de Paris, Département de Dermatologie, Hôpital Saint-Louis, Paris, France.,Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
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