J Wound Manag Res.  2019 Mar;15(1):48-51. 10.22467/jwmr.2019.00626.

Pyoderma Gangrenosum Overlying Venous Insufficiency: An Inevitable Misdiagnosis

• Park J
• Jeong GJ
• Hong JY
• Park KY
• Kim BJ
• Kim WS

• KMID: 2469762
• DOI: http://doi.org/10.22467/jwmr.2019.00626

Abstract

Pyoderma gangrenosum (PG) is a destructive inflammatory disease characterized by painful ulcerative lesions with neutrophilic infiltration in the dermis. Although the etiology and pathogenesis are poorly understood, uncontrolled inflammatory responses to nonspecific stimuli may trigger the development of PG. Here, we report a rare case of PG arising above a venous insufficiency lesion. The most typical diagnosis for an ulcer at such a location is venous ulcer. However, our atypical case of PG emphasizes that PG can be induced by ischemic conditions, such as venous insufficiency. Debridement and skin grafting, which were performed based on an incorrect diagnosis, worsened the PG lesion and provoked a severe pathergy phenomenon. Thus, surgeons should consider PG in the differential diagnosis of intractable venous ulcers in order to ensure an accurate diagnosis and prompt treatment.

Keyword

Pyoderma gangrenosum; Venous insufficiency; Venous ulcer

MeSH Terms

Debridement
Dermis
Diagnosis
Diagnosis, Differential
Diagnostic Errors*
Neutrophils
Pyoderma Gangrenosum*
Pyoderma*
Skin Transplantation
Surgeons
Ulcer
Varicose Ulcer
Venous Insufficiency*