title: Pyoderma gangrenosum--a postoperative "pseudo-infection".
abstract: Pyoderma gangrenosum is a skin ulcerative necrosis, due to dermal neutrophilic infiltration, through a non-infectious exacerbation of cell -mediated immunity. Being characterized by pathergy, the disease may be triggered by surgery; in this case, it is easily mistaken for a postoperative infection. We report a case of pyoderma gangrenosum after coronary artery bypass surgery. The patient developed, from the 7th postoperative day, around the incisions, dermo-epidermic lesions specific for the disease, high fever with chills and a severe biological inflammatory syndrome. Treatment for wound sepsis was ineffective. After pyoderma gangrenosum was recognized, corticosteroids (Prednisone 80 mg/d) led, in two days time, to a spectacular improvement, and in 7 weeks, to complete epithelization of the lesions. If after debridement of a supposedly infected wound (with pustules, bullae or ulcerations), there is no improvement, but a centrifugal extension of the lesions, with a "sepsis-like" syndrome and persistent negative cultures, one should think at pyoderma gangrenosum; in that case, not the antibiotics, but corticosteroids (or other immunosuppressants) are the treatment.
authors.affiliation: Cardiac Surgery Unit no. 2, "Prof. Dr. C.C. Iliescu" Emergency Institute for Cardiovascular Disease, Bucharest, Romania. iosifescuag@yahoo.com
authors.forename: A G
authors.initials: AG
authors.lastname: Iosifescu
authors.forename: C I
authors.initials: CI
authors.lastname: Boiangiu
authors.forename: C M
authors.initials: CM
authors.lastname: Comănescu
authors.forename: V A
authors.initials: VA
authors.lastname: Iliescu
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D017511:Pyoderma Gangrenosum / Q000188:drug therapy / Q000209:etiology*; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology*; D035441:Thoracic Wall; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D011241:Prednisone