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
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.


CONCLUSIONS
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.
Department of Plastic Surgery, Loma Linda University, Loma Linda, CA, USA. wewong@llu.edu
Wendy W
WW
Wong
Gustavo R
GR
Machado
Michael E
ME
Hill
D000293:Adolescent; D003093:Colitis, Ulcerative / Q000150:complications; D003424:Crohn Disease / Q000150:complications; D003646:Debridement; D048909:Diabetes Complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006229:Hand Dermatoses / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D009369:Neoplasms / Q000150:complications; D017511:Pyoderma Gangrenosum / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery*