Postoperative Pyoderma Gangrenosum: Rare Infection Mimic and Diagnostic Challenge - A Case Report

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that can occur in the postoperative period, often mimicking surgical site infections (SSIs). The clinical overlap between PG and SSIs - including erythema, wound dehiscence, and purulent discharge - makes timely diagnosis challenging.

A 61-year-old female with a history of ovarian cancer and metachronous liver metastasis underwent an open left hemihepatectomy. On the fifth postoperative day, she developed erythema, wound dehiscence, and necrosis unresponsive to broad-spectrum antibiotics. Wound cultures remained sterile. Dermatologic consultation and histopathology confirmed the diagnosis of PG, characterized by dense neutrophilic infiltration and pyogenic folliculitis. High-dose corticosteroid therapy led to marked clinical improvement within 5 days, with full wound healing achieved by discharge.

Postoperative PG should be considered in non-resolving postoperative wound complications with negative cultures and antibiotic failure. In this context, prior exposure to PARP inhibitors may be a biologically plausible cofactor through immune modulation; however, a causal link remains unproven. Early dermatology consultation and biopsy are essential to avoid harmful debridement and expedite immunosuppression.