Post Reduction Mammaplasty Pyoderma Gangrenosum: An Unusual Presentation of a Misdiagnosed Entity

Pyoderma gangrenosum is a rare skin disorder that could be triggered after surgical trauma. However, more uncommon, this condition could follow breast surgery. An opportune diagnosis and adequate treatment are essential in order to avoid wound chronicity and aesthetic sequels. We report a 51-year-old woman who presented multiple wound complications after a reduction mammaplasty. This particular case is unique, because bilateral and unusual presentation after another uncomplicated previous surgical procedure, and illustrates how a patient could be taken through different rational surgical therapeutic modalities without improvement, and deterioration of clinical picture. Finally, a diagnosis of Pyoderma gangrenosum was established, and immunosuppressive treatment was completed, with an appropriate resolution of this problematic condition.

Autoimmune Hemolytic Anemia After Cyanocobalamin Replacement in a Patient With a Previous Diagnosis of Pernicious Anemia: A Case Report

Pernicious anemia (PA) is associated with other autoimmune diseases, such as hypothyroidism, type 1 diabetes mellitus (DM1), Addison's disease, and vitiligo. The association between PA and autoimmune hemolytic anemia (AIHA) is rare, with less than 30 cases reported in the literature. In this paper, we report a case of a patient with a confirmed diagnosis of PA, who, six months after starting treatment with cyanocobalamin, presented with severe hemolysis with a positive direct antiglobulin test (DAT) for warm antibodies; the patient responded well to glucocorticoid treatment. AIHA in PA patients can be triggered by cyanocobalamin replacement due to the expression of membrane antigens by mature red blood cells entering into the peripheral circulation. This association should be considered because these patients, in addition to cyanocobalamin replacement, will require immunosuppressive treatment, usually with glucocorticoids.