Rare Complication after Cardiac Surgery: A Case Report of Pyoderma Gangrenosum

Abstract

Pyoderma gangrenosum is an uncommon, idiopathic, chronic ulcerative inflammatory skin disease characterized by a rapidly progressive necrosis of the wound edges, and mimics a postoperative infection. Few cases have been reported after cardiothoracic surgery. We present a case of a pyoderma gangrenosum occurring after coronary artery bypass graft.

Clinical features of pyoderma gangrenosum and current diagnostic trends

“…Establishing firm criteria for diagnosing PG ensures that case reports describe the same disease, which has implications in optimizing treatment strategies and improving patient outcomes. 13 Ferrandiz-Pulido et al 13 Barker 14 Lindberg-Larsen and Fogh 15 Sripathi et al 16 Parren et al 17 27 Kim et al 28 Alkhouri et al 29 Tinoco et al 30 Spear 31 Mariscalco et al 32 Rashid 33 Aseni et al 34 …”

Postoperative pathergic pyoderma gangrenosum after aortic aneurysm repair

“…Postoperative or pathergic pyoderma gangrenosum is an uncommon variant of pyoderma gangrenosum that may be considered a type of wound complication because it only develops at sites of pathergy (cutaneous lesions arise following trauma to the skin) 1–3 . Clinically, PPG often begins as erythema surrounding a surgical wound, followed by coalescence, wound dehiscence, and drainage of fibrinous exudates 3–5 . For this reason, a diagnosis of PPG is often delayed, and other more common etiologies of wound breakdown, including infectious processes and tissue ischemia, are primarily considered 2,3 .…”

“…For this reason, a diagnosis of PPG is often delayed, and other more common etiologies of wound breakdown, including infectious processes and tissue ischemia, are primarily considered 2,3 . Diagnosis of PPG is primarily clinical, but histopathologic features may provide further evidence to support the diagnosis of a neutrophilic dermatosis, especially if cultures are negative 3,5 …”

“…Despite the rarity of this surgical complication, a high index of clinical suspicion for PPG is important when considering the diagnostic approach to a patient with wound breakdown. Although infectious processes and tissue ischemia remain the most common postoperative cutaneous surgical complications, physicians who are appropriately suspicious of PPG, by appreciating its annular morphology and adjacency to wound edges, can decrease patient morbidity and mortality 4,5 . The use of antibiotics in a patient with PPG may be futile, and surgical wound debridement is likely to cause considerable worsening because of underlying pathergy 3–5 .…”

“…Although infectious processes and tissue ischemia remain the most common postoperative cutaneous surgical complications, physicians who are appropriately suspicious of PPG, by appreciating its annular morphology and adjacency to wound edges, can decrease patient morbidity and mortality 4,5 . The use of antibiotics in a patient with PPG may be futile, and surgical wound debridement is likely to cause considerable worsening because of underlying pathergy 3–5 . Importantly, failure to diagnose PPG may lead to further tissue loss 4,5 …”