Pyoderma gangrenosum after totally implanted central venous access device insertion

Abstract

Background: Pyoderma gangrenosum is an aseptic skin disease. The ulcerative form of pyoderma gangrenosum is characterized by a rapidly progressing painful irregular and undermined bordered necrotic ulcer. The aetiology of pyoderma gangrenosum remains unclear. In about 70% of cases, it is associated with a systemic disorder, most often inflammatory bowel disease, haematological disease or arthritis. In 25-50% of cases, a triggering factor such as recent surgery or trauma is identified. Treatment consists of local and systemic approaches. Systemic steroids are generally used first. If the lesions are refractory, steroids are combined with other immunosuppressive therapy or to antimicrobial agents.

Pyoderma gangrenosum with an underlying ulcerative colitis associated with bone tuberculosis

“…[34] Although the cause remains obscure, most probably an immunological anomaly of the hyperergic reaction type has been implicated. [5] PG most commonly occurs in adults aged 30-50, with a higher predilection for lower extremities and trunk. Several variants have been described; ulcerative, pustular, bullous, vegetative, vulvar and peristomal.…”

“…[134] These often start as a small papule or collection of papules, which break to form small ulcers with a “cat's paw” appearance that coalesce to form a single ulcer with central necrosis[2] and have sharply demarcated undermined edges with violaceous border. [1–35–7] Lesions are less than 10 cm in size, but can be very large. They tend to endure, lasting months to years and heal with an atrophic cribriform scar.…”

“…Recently, good outcomes have been reported for treatments with anti-tumor necrosis factor α, and infliximab. [5]…”

Overview of extravasation management and possibilities for risk reduction based on literature data

“…Mrs. Zatkó reported complications with "no serious consequences" (but not precisely determined) in case of 0.1 %, but the incidence of all events is not detailed 2 . The risk of extravasation can be reduced significantly by using centrally vein accessed ports and subcutaneously implanted "reservoirs" (subcutaneously implanted ports), but using this method cannot even guarantee to avoid this complication and in addition to the effects of cytostatic agents escaping into the tissues centrally, also unusual complications may develop [5,10,11,[18][19][20][21][22][23][24][25][26][27] .…”

Torsion of Appendix Epiploica: A Rare Cause of Acute Right Iliac Fossa Pain

“…The ulcerative form of pyoderma gangrenosum is characterized by a rapidly progressing painful irregular and undermined bordered necrotic ulcer. 2 Lesions can be solitary or multiple, chronic or recurrent. Any site on the body is prone to developing this skin dermatosis.…”