Abstract
Pyoderma gangrenosum (PG) is an uncommon, ulcerative skin disease that is often associated with systemic diseases. Herein, we report a development of PG in a surgical site after cholecystectomy that was difficult to discriminate from surgical site infection. The patient was a 74-year-old man who had previously been diagnosed with myelodysplastic syndrome (MDS). Laparoscopic cholecystectomy was planned under diagnosis of cholecystolithiasis, but we converted to open cholecystectomy. The surgical wound was partially erythematous 4 days after surgery. In spite of opening the wound, cleansing it with sterile saline, and administration of antibiotics, inflammation spread with erosion. The clinical manifestations and histopathologic features of biopsy specimen indicated that diagnosis of PG associated with MDS was most likely. Administration of glucocorticoids made a rapid response of skin inflammation. The differential diagnosis of postoperative wound healing complications that were unresponsive to conventional wound local care and antibiotic therapy should include PG, especially in patients with systemic diseases such as MDS.
Highlights
Pyoderma gangrenosum (PG) is an uncommon, ulcerative skin disease, and characterized by a rapidly enlarging necrotic ulceration with an undermined border and a surrounding of erythema [1,2,3,4,5]
It is often associated with systemic illness, such as inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and myelodysplastic syndrome (MDS) [6, 7]
We report a development of PG in a surgical site after cholecystectomy that was difficult to discriminate from surgical site infection
Summary
Pyoderma gangrenosum (PG) is an uncommon, ulcerative skin disease, and characterized by a rapidly enlarging necrotic ulceration with an undermined border and a surrounding of erythema [1,2,3,4,5] It is often associated with systemic illness, such as inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and myelodysplastic syndrome (MDS) [6, 7]. Laparoscopic cholecystectomy was planned, but we converted to open cholecystectomy with a right subcostal oblique incision because it was difficult to These clinical and histopathologic findings of the surgical site indicated that diagnosis of PG associated with MDS was most likely. After the addition of a systemic administration of 30 mg/day prednisolone to local care of the surgical site with moist dressing, fever had been rapidly alleviated, spread of rash had diminished, edema in the lower body had improved, and the purulent coating had disappeared on the eroded skin surface surrounding the open wound (Fig. 3a). The surface of the wound was covered with satisfactory granulation tissue, and normal wound healing was achieved after administration of 5 mg/day prednisolone for 1 year (Fig. 3b)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
