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

Pyoderma gangrenosum (PG) is a rare, ulcerative neutrophilic dermatosis that presents significant diagnostic challenges due to its clinical heterogeneity and lack of definitive laboratory markers. Misdiagnosis often leads to inappropriate treatments, delayed recovery, and increased morbidity. We report two cases of PG at opposite ends of the age spectrum-a 90-year-old male and a 10-year-old boy-each initially misdiagnosed as chronic infective ulcers. Both patients demonstrated classical features of PG, including rapid ulcer progression, pathergy phenomenon, undermined violaceous borders, and non-responsiveness to antimicrobial therapy. Despite the absence of histopathological confirmation, clinical diagnosis was established using the Delphi Consensus Criteria (2018), with both cases fulfilling seven of eight minor diagnostic criteria. Initiation of systemic corticosteroids led to rapid and sustained clinical improvement, underscoring the role of early immunosuppressive therapy. These cases highlighted the critical importance of considering PG in patients with non-healing ulcers unresponsive to standard therapy, particularly when pathergy and clinical red flags are present. Clinicians should adopt a high index of suspicion and utilize validated diagnostic frameworks to avoid unnecessary interventions and optimize patient outcomes, especially in atypical age groups.