Risk of developing pyoderma gangrenosum after procedures in patients with a known history of pyoderma gangrenosum—A retrospective analysis

Xia, Fandi; Liu, Kristina Jing; Lockwood, Stephen J.; Butler, David F.; Tsiaras, William G.; Joyce, Cara; Mostaghimi, Arash

doi:10.1016/j.jaad.2017.09.040

Cited by 33 publications

(22 citation statements)

References 7 publications

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“…More invasive procedures and patients with chronic disease have a higher risk of developing this subtype. In one retrospective analysis, about 15% of individuals had post-surgical recurrence or exacerbation of existing lesions 24 . PG was often diagnosed as a wound infection at first, leading to debridement and ultimately worsening the lesion because of pathergy.…”

Section: Clinical Presentation and Comorbiditiesmentioning

confidence: 99%

Recent advances in managing and understanding pyoderma gangrenosum

2019

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Pyoderma Gangrenosum (PG) is a rare neutrophilic dermatosis with multiple different clinical presentations and associated comorbidities. PG has historically been a challenging disorder to diagnose, leading to the development of new diagnostic criteria rather than the traditional approach of a diagnosis of exclusion. The pathophysiology is thought to involve both innate and adaptive immune system dysregulation, neutrophilic abnormalities, environmental, and genetic factors. As of today, no gold standard therapy exists for the treatment of PG, and the literature is restricted to mainly case reports, case series, and 2 small randomized clinical trials. Topical, systemic, and biologic therapy, as well as adequate analgesia and proper wound care all play a role in the management of PG. Recent studies have identified additional cytokines and signalling cascades thought to be involved in the pathogenesis of PG, ultimately leading to the development of new targeted therapies. This review will focus on recent advances in the pathophysiology, clinical presentation and associated comorbidities, diagnosis, and management of PG.

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Section: Clinical Presentation and Comorbiditiesmentioning

confidence: 99%

Recent advances in managing and understanding pyoderma gangrenosum

2019

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“…Adhering to the current recommendations in the literature regarding surgery for PG lesions and the case report of Long et al [11], we were able to perform disease-unrelated surgery free of complications in our described patient. The retrospective study of Xia et al [18] reported only a 15.1% occurrence of PG lesions after surgical procedures; thus, the PG-free course of our arthroplasty surgery cannot be attributed solely to our treatment regimen.…”

Section: Discussionmentioning

confidence: 74%

Hemiarthroplasty in a patient with femoral neck fracture and pyoderma gangrenosum: a case report and review of the literature

et al. 2020

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Background: Pyoderma gangrenosum is a rare ulcerating skin disease of unknown etiology, making its coincidence with orthopedic trauma a rare challenge. Patients are at risk of progression of the existing lesions and development of new lesions upon skin injury when surgical procedures are performed. To our knowledge, this is the first report in the literature of disease unrelated surgery during active pyoderma gangrenosum. Case presentation: We present a case of femoral neck fracture in a Caucasian patient with concurrent pyoderma gangrenosum localized in the axilla. Hemiarthroplasty was safely performed after disease activity was reduced with systemic corticosteroids. Tissue-protective wound closure was used together with perioperative corticosteroids and antibiotics. No signs of pyoderma gangrenosum developed at the surgical wound site, and the axillary lesions showed constant improvement until healing with scar tissue. Conclusions: In our patient, the preoperative steroid treatment, perioperative antibiotics, and soft tissue protective surgical technique led to successful management of this rare coincidence.

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“…Pathergy has a pivotal role in inducing new post-surgical skin PG in patients with a preexisting diagnosis of PG. However, while cutaneous PG has been frequently reported after surgical procedures involving the skin, especially breast surgery (16), visceral PG involvement is usually not related to previous surgery. This may be due to the fact that visceral PG is a very rare condition and its diagnosis may be difficult to reach.…”

Section: Discussionmentioning

confidence: 99%

Post-surgical Thyroid Bed Pyoderma Gangrenosum Mimicking Recurrent Papillary Thyroid Carcinoma

et al. 2019

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Background: Pyoderma gangrenosum (PG) is a rare inflammatory disease presenting with chronic-recurrent cutaneous ulcers histopathologically hallmarked by neutrophilic infiltrates, which may occur more frequently at sites of surgical traumas. The disease is habitually limited to the skin, but it can virtually involve any organ. Nevertheless, no prior cases of PG involving the thyroid bed have ever been reported. Case Report: A bilateral PG of the breast was diagnosed in a 51-year-old woman and treated with intravenous methylprednisolone pulse-therapy and cyclosporine, with partial improvement. During the hospitalization, cytological examination of two hypoechoic thyroid nodules by fine-needle aspiration (FNA) was consistent with thyroid carcinoma. After total thyroidectomy, histopathology confirmed a papillary thyroid cancer (PTC), and radioactive iodine ablation was performed. At 12-month ultrasonographic follow-up, two hypoechoic avascular areas localized in the empty thyroid bed raised the suspect of PTC recurrence. However, (i) undetectable levels of thyroglobulin without anti-thyroglobulin antibodies, (ii) neutrophilia and increased inflammatory marker levels, and (iii) cytological examination of FNA showing numerous neutrophils induced to suspect thyroid bed PG infiltration. An ex juvantibus approach with high-dose methylprednisolone led to dimensional reduction of the hypoechoic areas on ultrasonography, thus confirming the hypothesis of thyroid bed PG. Conclusion: This case of thyroid bed PG supports the idea that PG reflects a cutaneous phenotype encompassed in the spectrum of systemic neutrophilic diseases. Endocrinologists should be aware that thyroid bed PG involvement is an albeit rare differential diagnosis to consider in patients who had undergone thyroid surgery, especially with a history of PG.

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Risk of developing pyoderma gangrenosum after procedures in patients with a known history of pyoderma gangrenosum—A retrospective analysis

Abstract: M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT

Cited by 33 publications

References 7 publications

Recent advances in managing and understanding pyoderma gangrenosum

Recent advances in managing and understanding pyoderma gangrenosum

Hemiarthroplasty in a patient with femoral neck fracture and pyoderma gangrenosum: a case report and review of the literature

Post-surgical Thyroid Bed Pyoderma Gangrenosum Mimicking Recurrent Papillary Thyroid Carcinoma

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