Abstract
BackgroundPyoderma gangrenosum is an aseptic skin disease. The ulcerative form of pyoderma gangrenosum is characterized by a rapidly progressing painful irregular and undermined bordered necrotic ulcer. The aetiology of pyoderma gangrenosum remains unclear. In about 70% of cases, it is associated with a systemic disorder, most often inflammatory bowel disease, haematological disease or arthritis. In 25–50% of cases, a triggering factor such as recent surgery or trauma is identified. Treatment consists of local and systemic approaches. Systemic steroids are generally used first. If the lesions are refractory, steroids are combined with other immunosuppressive therapy or to antimicrobial agents.Case presentationA 90 years old patient with myelodysplastic syndrome, seeking regular transfusions required totally implanted central venous access device (Port-a-Cath®) insertion. Fever and inflammatory skin reaction at the site of insertion developed on the seventh post-operative day, requiring the device's explanation. A rapid progression of the skin lesions evolved into a circular skin necrosis. Intravenous steroid treatment stopped the necrosis' progression.ConclusionEarly diagnosis remains the most important step to the successful treatment of pyoderma gangrenosum.
Highlights
Pyoderma gangrenosum is an aseptic skin disease
Patients undergoing totally implanted central venous access device (TICVAD) insertion are frequently at risk of infection, firstly by implanting foreign material, which can be colonized and difficult to treat, secondly because the underlying disease often is associated with a decreased immune response such as metastatic malignant diseases and haemopathies
The first aetiology of inflammatory ulcerative skin lesions associated with TICVAD insertion is usually assumed to be bacterial infection [1]
Summary
Patients undergoing totally implanted central venous access device (TICVAD) insertion are frequently at risk of infection, firstly by implanting foreign material, which can be colonized and difficult to treat, secondly because the underlying disease often is associated with a decreased immune response such as metastatic malignant diseases and haemopathies. The first aetiology of inflammatory ulcerative skin lesions associated with TICVAD insertion is usually assumed to be bacterial infection [1]. A 90 year-old patient in good general health, known for a myelodysplastic syndrome with refractory anaemia and myelofibrosis, became transfusion and thrombapheresis dependent, requiring implantation of a right subclavian TICVAD. Thereafter he developed dyspnoea and a fever of 38.6°C, motivating hospitalisation at the 7th postoperative day. Important skin inflammation with central necrotic ulceration and violet coloration of the edges was noted on the site of the TICVAD (figure 1 and 2). Cultures showed that pathogenic bacteria are not involved Despite these antibiotics, a fever and an inflammatory state persisted. The diagnosis of PG was not evoked at that time
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