title: Fatal pyoderma gangrenosum with pathergy after coronary artery bypass grafting.
abstract: Surgeons and others who perform invasive procedures should be aware of the possibility of pyoderma gangrenosum and the risk of pathergy in patients who have a history of unexplained skin ulcers or poor wound-healing. We report the case of a 70-year-old man in whom diffuse erythema over the anterior chest wall and marked leukocytosis developed after coronary artery bypass grafting. This prompted débridement and opening of the sternotomy wound. The cause of the erythema was pyoderma gangrenosum that expressed the pathergy phenomenon. The pyoderma gangrenosum subsequently involved the saphenous vein harvest site, a chest-tube site, and a previously healed abdominal scar. The patient died when an exposed saphenous vein graft was perforated. To our knowledge, this is the 9th reported case of pathergy due to pyoderma gangrenosum after coronary artery bypass grafting and the first with a fatal outcome.
authors.affiliation: Department of Internal Medicine, Providence Hospitals, Columbia, South Carolina 29203, USA. cboslerian@gmail.com
authors.forename: Charles S
authors.initials: CS
authors.lastname: Bryan
mesh_terms: D000368:Aged; D001706:Biopsy; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000601:surgery*; D003646:Debridement / Q000379:methods; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D017511:Pyoderma Gangrenosum / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012867:Skin / Q000473:pathology
keywords: Coronary artery bypass/complications; diagnosis, differential; fatal outcome; postoperativecomplications/diagnosis/drug therapy/pathology; pyoderma gangrenosum/complications/diagnosis/etiology/pathology/therapy; risk factors; skin ulcer/diagnosis; skin/injuries/pathology; surgical wound infection/diagnosis; wound healing