Rare Presentation of Postsurgical Pyoderma Gangrenosum Presenting as Necrotizing Soft Tissue Infection.
Rod L Flynn, Mashiul H Chowdhury, Joseph Rudolph and 1 others
PMID 31498172WHAT IT FOUND
A man developed painful, spreading wounds after rectal surgery despite negative cultures and scans.
Stopping sharp debridement and starting steroids on day 21 was followed by rapid symptom improvement, with abdominal healing at 13 weeks.
Key findings
01On postoperative day 8, the patient had new extreme fatigue and increased perineal pain, with erythema and early dehiscence; blood and urine cultures were negative, and CT on postoperative day 9 showed no abscess.
02All sharp debridement was discontinued, and IV methylprednisolone was started on postoperative day 21; abdominal pain improved within hours and erythema stabilized.
03The abdominal wound fully epithelialized and healed within 13 weeks, and the perineal wound reached full epithelialization in 51 weeks.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a case report, so it cannot show that any treatment caused the improvement. The patient had chemoradiation, APR, multiple antibiotics, antifungal therapy, debridement, negative-pressure wound therapy, and specialized dressings, so the effect of any single component cannot be separated. The authors state that pyoderma gangrenosum is usually a diagnosis of exclusion and that the biopsy findings were not specific for pyoderma gangrenosum.
The easy way to misread this
Do not conclude that systemic steroids healed the wounds. This is a case report, and the patient also had chemoradiation, APR, multiple antibiotics, antifungal therapy, debridement, negative-pressure wound therapy, and specialized dressings.