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Pyoderma Gangrenosum Masquerading as Chronic Infective Ulcers: Two Case Reports Across Age Extremes

Amrit Neupane1, Shivendra Kumar Jha1, Anisha Basukala1

  • 1Sukraraj Tropical & Infectious Disease Hospital Kathmandu Nepal.

Clinical Case Reports
|May 18, 2026
PubMed

Insights

Pyoderma gangrenosum (PG) is a rare skin condition that is difficult to diagnose. Early recognition and treatment with corticosteroids are crucial for managing this ulcerative neutrophilic dermatosis.

Area of Science:

  • Dermatology
  • Immunodermatology

Background:

  • Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by ulcerative lesions.
  • Diagnostic challenges arise from clinical heterogeneity and lack of specific markers, leading to misdiagnosis and delayed treatment.
  • Early misdiagnosis of PG as infectious ulcers can increase patient morbidity.

Purpose of the Study:

  • To report two cases of pyoderma gangrenosum (PG) in atypical age groups (elderly and child).
  • To highlight diagnostic challenges and the utility of the Delphi Consensus Criteria in managing PG.
  • To emphasize the importance of early immunosuppressive therapy for PG.

Main Methods:

  • Case report of a 90-year-old male and a 10-year-old boy with pyoderma gangrenosum.
  • Clinical diagnosis based on the Delphi Consensus Criteria (2018), fulfilling seven of eight minor criteria.
  • Treatment with systemic corticosteroids and monitoring of clinical response.

Main Results:

  • Both patients presented with non-healing ulcers, rapid progression, pathergy, and lack of response to antimicrobials.
  • Clinical diagnosis of PG was established despite absent histopathological confirmation.
  • Systemic corticosteroids resulted in rapid and sustained improvement in both cases.

Conclusions:

  • Pyoderma gangrenosum should be considered in non-healing ulcers unresponsive to standard treatments, especially with features like pathergy.
  • The Delphi Consensus Criteria provide a valuable framework for clinical diagnosis of PG.
  • Prompt initiation of immunosuppressive therapy, such as corticosteroids, is essential for favorable outcomes in PG.
Keywords:
chronic non‐healing ulcerneutrophilic dermatosispathergypyoderma gangrenosum

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