Pyoderma Gangrenosum: An Uncommon Case Report and Review of the Literature

Pyoderma gangrenosum (PG) is a rare ulcerative condition that is diagnostically and therapeutically challenging, as debridement leads to ulcer deterioration (pathergy phenomenon); immunosuppression is considered the gold standard therapy.

The authors present the case of a 42-year-old woman with PG and uncontrolled iatrogenic diabetes, secondary to a total pancreatectomy performed in another hospital in 1998 due to nesidioblastosis. In 2008, she was referred to the diabetic foot consultation at Centro Hospitalar Tondela-Viseu (Viseu, Portugal) due to an infected wound on the left leg thought to be related to a trauma from footwear, but the injury worsened despite treatment. Characteristics of the lesion led to the diagnosis of PG and treatment was adjusted. The patient was followed-up weekly at the diabetic foot consultation; at 2-months follow-up, the leg ulcer was closed but additional lesions emerged in multiple areas of her body. Therapy included local antiseptics, antibiotics, pain control, systemic corticosteroids, immunosuppressors, intravenous immunoglobulin, and surgical debridement. Due to her noncompliance, this proved to be a challenging case.

Although PG is rare, clinicians should suspect it in the presence of purplish wound edges with a necrotic center. Surgical debridement, while necessary in other ulcers, can worsen the condition and should only be applied to self-detachable necrotic plaques.