Pyoderma gangrenosum. A possible cause of wound necrosis
S. D. Schwaitzberg, M. W. Bradshaw and T. W. Williams Jr
Pyoderma gangrenosum is a destructive cutaneous disorder characterized by
painful, rapidly enlarging ulcers with under-mined bluish and purplish red
margins. This disease is most frequently found in association with
ulcerative colitis. However, in the last three years, four cases of
pyoderma gangrenosum precipitated by surgical procedures have occurred, and
only one of these patients had ulcerative colitis. All four patients
responded to steroid therapy and local wound care. Pyoderma gangrenosum can
first be suspected by recognition of the previously described classic
lesion. In addition, the absence of significant microbial growth and the
lack of a specific etiology ascertained on routine and special staining of
biopsy material is suggestive of the diagnosis. Histologic characteristics
are entirely nonspecific but can be helpful in ruling out other specific
entities. The progressively destructive nature of this process in the face
of what would seem to be appropriate therapy for bacterial wound infection
requires that pyoderma gangrenosum, as well as other aspects of the
differential diagnosis of a persistent ulcerative lesion, such as fungal
infection, factitious ulcer, or vasculitis, be considered.
