Pyoderma gangrenosum after totally implanted central venous access device insertion.
BACKGROUND
Pyoderma gangrenosum is an aseptic skin disease. The ulcerative form of pyoderma gangrenosum is characterized by a rapidly progressing painful irregular and undermined bordered necrotic ulcer. The aetiology of pyoderma gangrenosum remains unclear. In about 70% of cases, it is associated with a systemic disorder, most often inflammatory bowel disease, haematological disease or arthritis. In 25-50% of cases, a triggering factor such as recent surgery or trauma is identified. Treatment consists of local and systemic approaches. Systemic steroids are generally used first. If the lesions are refractory, steroids are combined with other immunosuppressive therapy or to antimicrobial agents.


METHODS
A 90 years old patient with myelodysplastic syndrome, seeking regular transfusions required totally implanted central venous access device (Port-a-Cath(R)) insertion. Fever and inflammatory skin reaction at the site of insertion developed on the seventh post-operative day, requiring the device's explanation. A rapid progression of the skin lesions evolved into a circular skin necrosis. Intravenous steroid treatment stopped the necrosis' progression.


CONCLUSIONS
Early diagnosis remains the most important step to the successful treatment of pyoderma gangrenosum.
Inan
Ihsan
I
Visceral Surgery Unit, Department of Surgery, Geneva University Hospital, Rue Micheli-du-Crest 24, CH-1211 Geneva, Switzerland. ihsan.inan@hcuge.ch
Myers
Patrick O
PO
Braun
Rolf
R
Hagen
Monica E
ME
Morel
Philippe
P
D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000628:therapy; D017511:Pyoderma Gangrenosum / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
D007166:Immunosuppressive Agents