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Pyoderma Gangrenosum after Cardiac Surgery.

Asen Petrov1, Utz Kappert1, Torsten Schmidt2

  • 1Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.

The Thoracic and Cardiovascular Surgeon
|December 11, 2021
PubMed
Summary
This summary is machine-generated.

Pyoderma gangrenosum is a rare skin condition that can mimic sternal wound infections after cardiac surgery. Early diagnosis and immunosuppressive therapy are crucial to avoid fatal mistreatment.

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Area of Science:

  • Cardiology
  • Dermatology
  • Infectious Diseases

Background:

  • Pyoderma gangrenosum (PG) is a rare, noninfectious ulcerative skin disease.
  • It frequently mimics sternal wound infections following cardiac surgery, leading to diagnostic challenges.

Approach:

  • A systematic literature review was conducted on PubMed and Cochrane databases (September 1985–September 2020).
  • Analyzed 15 studies involving 15 patients with PG post-cardiac surgery.

Key Points:

  • PG onset occurs a median of 5 days post-surgery, predominantly in males (81.3%) aged 64 years.
  • Clinical presentation includes rapid progression, wound border changes, fever, malaise, pain, and pathergy.
  • Diagnosis requires biopsy confirming neutrophilic inflammation; initial treatment often misdirected towards surgical site infection.

Conclusions:

  • PG is an exclusion diagnosis with treatment opposite to surgical site infection.
  • Knowledge of PG diagnosis and treatment is vital to prevent fatal mistreatment.
  • Delayed diagnosis and incorrect treatment led to a 12.5% mortality rate.