Pyoderma Gangrenosum in the Absence of Any Underlying Predisposing Condition: A Diagnostic Dilemma

Pyoderma gangrenosum (PG) is a rare non-infectious skin disease of undetermined origin. It is characterized by a single or multiple painful, necrotic ulcers. Formerly, PG was assumed to be infectious, but eventually, it was established to be an inflammatory disorder that is commonly associated with autoimmune and neoplastic diseases. We report a case of PG in a 70-year-old female who presented on the pretibial area as a single non-healing ulcer. It started as a small induration that worsened over the course of two weeks despite being on antibiotics. We started the patient on corticosteroids and high potency topical steroids that resulted in healing of the ulcer. PG can prove to be a diagnostic dilemma and can be inappropriately treated with antibiotics or even something radical like an amputation if misdiagnosed. Hence, physicians need to think of this entity even in the absence of any predisposing conditions.