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Untreatable surgical site infection: consider pyoderma gangrenosum
Ilan Berlinrut1, Nitasha Bhatia1, Jonathan M Josse1
1Department of Medical Education, St. George's University, Great River, N.Y.; Department of General Surgery and Department of Pathology, Hackensack University Medical Center, Hackensack, N.J.; and Department of General Surgery, University of Medicine and Dentistry of New Jersey, Newark, N.J.
Summary:
Pyoderma gangrenosum (PG) is an inflammatory disease characterized by sterile infiltration of the skin by neutrophils. We describe a case of a 63-year-old woman who developed PG following an abdominal wall reconstruction. Her initial presentation was thought to be consistent with a surgical site infection. Antibiotic therapy was initiated, and the patient was taken for multiple irrigation/lavage of her abdomen and debridement of necrotic tissue. Wound cultures remained negative, and maximal antibiotic coverage did not halt tissue breakdown. A trial of steroids was initiated, and the patient's condition subsequently improved. Tissue biopsy results were compatible with the diagnosis of PG.
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