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Pyoderma Gangrenosum Simulating Necrotizing Fasciitis.

Erik Friedrich Alex de Souza¹, Guilherme Almeida Rosa da Silva¹, Gustavo Randow Dos Santos¹

¹Federal University of the State of Rio de Janeiro (UNIRIO), Mariz e Barros Street, 775 Tijuca, RJ, Brazil.

Case Reports in Medicine

|January 20, 2016

Summary

Pyoderma gangrenosum, initially misnamed, is now understood as an autoimmune condition. This case highlights a rare presentation of pyoderma gangrenosum associated with myelodysplastic syndrome, successfully treated with prednisone.

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Area of Science:

Dermatology
Immunology
Hematology

Background:

Pyoderma gangrenosum (PG) was historically misattributed to bacterial infection but is now recognized as an autoimmune disorder.
Necrotizing fasciitis is a severe, rapidly progressing soft tissue infection leading to necrosis.
The case involves a patient presenting with symptoms initially suggestive of necrotizing fasciitis.

Purpose of the Study:

To report an unusual case of pyoderma gangrenosum.
To discuss the differential diagnosis between pyoderma gangrenosum and necrotizing fasciitis.
To highlight the association between pyoderma gangrenosum and myelodysplastic syndrome.

Main Methods:

Clinical presentation of a 59-year-old woman with a rapidly evolving ulcerative lesion.
Diagnostic workup including microbiological and histopathological analyses.
Treatment with oral prednisone and monitoring of patient outcome.

Main Results:

Microbiological tests were negative, ruling out bacterial infection.
Histopathology revealed epidermal necrosis and a neutrophil-rich inflammatory infiltrate.
The patient achieved complete healing of the pyoderma gangrenosum lesion within two months of treatment.

Conclusions:

The patient was diagnosed with pyoderma gangrenosum associated with myelodysplastic syndrome.
Early diagnosis and appropriate treatment with corticosteroids led to successful healing.
This case underscores the importance of considering pyoderma gangrenosum in the differential diagnosis of rapidly progressing ulcerative lesions, especially in patients with underlying hematological conditions.