A challenging diagnosis: case report of extensive pyoderma gangrenosum at multiple sites

Abstract

Mingwei J Ye,1,2 Joshua Mingsheng Ye,2 Leonard Wu,3 Cameron P Keating,4 Wai-Ting Choi41Department of Dermatology, Western Hospital, Footscray, VIC, Australia; 2University of Melbourne, Department of Medicine, Dentistry and Health Sciences, Parkville, VIC, Australia; 3Department of Pathology, Western Hospital, Footscray, VIC, Australia; 4Department of Plastic Surgery, Western Hospital, Footscray, VIC, AustraliaBackground: Pyoderma gangrenosum (PG) is a rare dermatological condition characterized by the rapid progression of a painful, necrolytic ulcer with an irregular, undermined border and commonly affects the lower extremities, mainly in the pretibial area. The diagnosis of PG is not easy. Due to lack of diagnostic laboratory test and histopathological findings indicative of PG, it is often misdiagnosed as an infection. This results in delayed or inappropriate treatment of the condition, which leads to devastating consequences such as limb amputation and death.Main observations: We report a rare case of a 51-year-old female who was initially diagnosed as having infected ulcers and underwent serial debridements, which resulted in extensive PG at three different sites (abdominal, left thigh, and sacral).Conclusion: This case highlights the challenges in diagnosing PG, emphasizes the key clinical features to aid diagnosis, and the clinical consequences of delayed or misdiagnosis of this condition.Keywords: postoperative complication, skin ulcer, surgical wound