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Pyoderma Gangrenosum Masquerading as Necrotizing Infection after Autologous Breast Reconstruction

Tae Hwan Park1,2, Kenneth L Fan1, Elizabeth G Zolper1

  • 1Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, D.C.

Plastic and Reconstructive Surgery. Global Open
|May 23, 2020
PubMed

Insights

Pyoderma gangrenosum (PG) can mimic surgical infections, complicating diagnosis after breast reconstruction. Key clinical signs like undermined borders and limited purulence aid surgeons in identifying this rare condition.

Area of Science:

  • Dermatology
  • Plastic Surgery

Background:

  • Pyoderma gangrenosum (PG) presents diagnostic challenges, especially when superimposed with infection after surgery.
  • Misdiagnosis can lead to inappropriate treatment, such as systemic steroids for necrotizing infections, causing significant morbidity.

Observation:

  • A case of autologous breast reconstruction is presented in a patient with no prior inflammatory disease history.
  • The patient developed a condition mimicking surgical site infection post-uncomplicated surgery.

Findings:

  • Critical diagnostic clues for PG in this context include irregular, violaceous, undermined borders.
  • Limited purulence confined to the skin, bilateral involvement, and abdominal wound compromise were noted.
  • Relative sparing of the mastectomy site, nipples, and umbilicus were important distinguishing features.

Implications:

  • Recognizing these subtle clinical signs is crucial for surgeons to consider PG early.
  • Accurate diagnosis prevents treatment-related complications and ensures appropriate management for patients with post-surgical PG.

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