Pyoderma gangrenosum: the great pretender and a challenging diagnosis.

BACKGROUND

The initial presentation of pyoderma gangrenosum (PG) is virtually indistinguishable from a pyogenic infection, making débridement appear necessary. However, operative approaches often lead to exacerbation and rapid extension through pathergy.

OBJECTIVE AND

METHODS

In attempts to increase awareness of this condition and minimize misdiagnoses, a review of published reports involving PG of the hand and digits was performed and included 35 patients in addition to our case of a 14-year-old female with a history of ulcerative colitis.

RESULTS

Of the total cases, 29 patients were misdiagnosed as having an infection and subsequently treated with antibiotics; 13 of these patients also had débridement of their lesions. Twenty-eight patients had associated medical conditions, including ulcerative colitis, Crohn disease, diabetes mellitus, and cancer.

CONCLUSION

When approached with a rapidly growing ulcerated lesion that does not respond to operative therapy, the possibility of PG should be entertained and a high-dose corticosteroid regimen and/or immunomodulator therapy implemented.