Introduction: Pyoderma gangrenosum (PG) is a rare non-infectious disorder, and presents as solitary or multiple, fragile papules that progresses to ulcer and necrotic tissue. Autoimmune is the favored pathophysiology associated with this chronic inflammatory skin disease. Systemic disease such as inflammatory bowel disease, rheumatoid arthritis, and haematological disorders often accompany PG. We report a case of recurred PG in 60 year old male with no evidence of associated systemic condition. Case Presentation: A 60 year-old male complained of 1 month-long painful ulceration on his left chest. The lesion started as a pustule which gradually increased in size and broke into painful ulcer. The patient had similar skin lesion, five and three years prior to this admission on the lower abdomen and lower limbs respectively. Both episodes healed more than a year. The diagnosis of ulcerative PG was established based on the physical and histopathological examination. The patient was treated with prednisone and moist wound care. The ulceration responded rapidly. Discussion: Pyoderma gangrenosum is associated with underlying disease in up to two-thirds of case. It occurs typically in adults between 40 and 60 years of age. Although PG predilection is typically lower extremities, any body site can be affected, especially following a trauma. Our patient presented with recurred PG but showed no other systemic condition. Autoinflammatory disease are clinically characterized by recurrent episode and the treatment is quite challenging for its tendency to become chronic, relapsing, or reversible ulcer. Conclusion. We report a rare case of recurred ulcerative PG with no symptom of associated systemic disease who responded rapidly with oral steroid treatment and moist wound care. Keywords: Pyoderma gangrenosum, ulcerative, autoimmune, case report, steroid.

Highlights: Gynecomastia is a known potential side effect of efavirenz, which may manifest in HIV patients. Healthcare providers should be vigilant and address the potential adverse effects of medications prescribed to individuals with HIV, including gynecomastia. Surgeons in resource-limited areas show flexibility and can achieve satisfactory results in procedures despite limited resources and surgical options. Abstract: Background: Human Immunodeficiency Virus (HIV) patients can now access antiretroviral drugs even in  resource-limited area. The majority of patients receive the fixed daily dose of an efavirenz-based antiviral (ARV) as advised by the World Health Organization (WHO), despite the fact that gynecomastia is a recognized side effect of evafirenz. Case Ilustration: We report a 31 year-old male with antiretroviral-associated gynecomastia that underwent the bilateral excision without liposuction procedure with satisfying result. Discussion: Surgeon in limited-resource area faces limited resources to perform some specific procedure. Meanwhile, limited resources also poses patients avoidable adverse events in otherwise clinical setting. The antiretroviral-associated gynecomastia is unavoidable because limited regimen choice. Surgeon needs also to adjust the surgical option to achieve satisfying result without instrument complexities. Conclusion: We reported satisfying surgical outcome in antiretroviral-associated bilateral gynecomastia patient with limited clinical setting.