Successful management of recurrence of lung surgery-induced pyoderma gangrenosum after pacemaker implantation: a case report

Abstract

BackgroundPyoderma gangrenosum begins as a painful erythema with induration, vesicles, or hemorrhagic pustules, which develops into serous ulcers. In addition to ulcerative colitis and myelodysplastic syndrome, surgical intervention may also induce this disease.Case presentationA 90-year-old man had previously undergone video-assisted thoracic surgery left upper lobectomy for left lung cancer. Blood tests on the 6th postoperative day showed elevated levels of white blood cells and C-reactive protein. The wound appeared red and drained pus; however, the wound culture was negative for bacteria. A skin biopsy was performed on the 13th postoperative day, and the patient was diagnosed with pyoderma gangrenosum. Tacrolimus hydrate ointment was administered, symptoms gradually improved around the 18th postoperative day, and the erythematous area shrank. The patient was discharged on the 50th postoperative day.Six months after lung surgery, a pacemaker was implanted in the left subclavian region. On the 6th postoperative day, the wound appeared reddish-brown and exudate was observed. On the 10th postoperative day, wound dehiscence was observed, and the pacemaker was removed. The patient was diagnosed with recurrent pyoderma gangrenosum and was re-treated with ointment. On the 29th postoperative day, a leadless pacemaker, which can be implanted with a small incision, was selected for treating arrhythmia. The patient was discharged 7 days after the second implantation.ConclusionWe report a recurrent pyoderma gangrenosum case following lung cancer surgery after pacemaker implantation as the second surgery, in which disease recurrence could be prevented by changing to a leadless pacemaker. Surgery and other invasive procedures should be avoided in pyoderma gangrenosum patients.