Pyoderma gangrenosum occurring at multiple surgical incision sites

Area of Science:

• Dermatology
• Gastroenterology
• Surgical Oncology

Background:

• Ulcerative colitis (UC) is a chronic inflammatory bowel disease.
• Surgical interventions like subtotal colectomy and ileostomy are common treatments for severe UC.
• Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis often associated with systemic diseases.

Observation:

• A 16-year-old female with UC developed wound drainage and back pain 10 weeks post-colectomy.
• Massive ulceration and skin separation appeared at abdominal and previous central venous line incision sites.
• Clinical presentation led to a diagnosis of pyoderma gangrenosum.

Findings:

• Pyoderma gangrenosum is infrequently observed in surgical wounds.
• This is the first reported instance of PG occurring simultaneously in multiple surgical sites in a UC patient.
• High-dose corticosteroid therapy resulted in rapid healing of all affected wound sites.

Implications:

• This case expands the understanding of pyoderma gangrenosum presentation in surgical contexts.
• Highlights the importance of considering PG in post-operative patients with unexplained wound complications, especially those with underlying inflammatory conditions.
• Suggests that prompt, high-dose steroid treatment can be effective for managing PG in surgical wounds.