Post-Operative Pyoderma Gangrenosum: A Long Journey for a Patient with Myelodysplastic Syndrome

Abstract

Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis, characterized by painful and erythematous papules, pustules or vesicles that rapidly become ulcerative and necrotic. These ulcers have multiple sub-types and can develop anywhere on the body. There are different postulations as to the mechanisms of development for each sub-type. More than half of patients with PG have an underlying disease, with the highest prevalence being inflammatory bowel disease (IBD), followed by inflammatory arthritis and hematological disorders. Post-operative PG should be considered in any patient undergoing surgery who subsequently develops characteristic necrotic lesions with delayed wound healing, fever and severe localized pain. The clinical manifestations and treatment may differ slightly depending on the type and cause of PG. Herein, we present a patient with myelodysplastic syndrome and arthritis, who underwent surgery for diverticulosis complicated by colovaginal fistula formation, and subsequently developed a very prolonged course of post-operative pyoderma gangrenosum. This report will address the types of PG, their various manifestations and pathogenesis, as well as the management specific to patients with myelodysplastic syndrome. It is our intent to better understand the sub-types in order to predict and prevent post-operative PG.

Postoperative Pyoderma Gangrenosum (PPG) After Appendectomy: A Case Report

“…Pyoderma gangrenosum is a rare, poorly understood immunologic disorder. It is an inflammatory neutrophilic dermatosis, characterized by painful and erythematous papules, pustules, or vesicles that rapidly progress to ulcerations with a violaceous and necrotic border [ 8 ]. It can affect any anatomical location with the exception of the nipple-areolar complex [ 4 ].…”

“…The principle guiding wound care in a patient with PG should be the avoidance of undue trauma or irritation of the wound surface and the prevention of secondary infection. If the surgery must be performed, it should be when the lesions are clinically inactive and debridement of the wound should be done only in the setting of extensive necrosis or uncontrollable superinfection [8,10,13].…”

A Rare Case of Severe Post-operative Pyoderma Gangrenosum After Surgery for Perforated Diverticulitis at the Sigmoid Colon

“…Pyoderma gangrenosum (PG) is a chronic, idiopathic, rapidly evolving cutaneous ulcerative condition. It is a non-infectious dermatosis characterized by painful erythematous papules, pustules, or vesicles that rapidly develop into ulcers with ragged, undermined, violaceous, or gunmetal-colored borders [1][2][3]. Approximately 50% of PG are associated with various autoimmune diseases, such as rheumatoid arthritis or inflammatory bowel disease (IBD), whereas almost 30% cases are idiopathic [1,4].…”