title: Pyoderma gangrenosum: an exceptional complication of venous access device.
abstract: BACKGROUND
  Pyoderma gangrenosum (PG) is a rare disease whose precise etiology remains unknown. It causes rapidly developing skin necrosis and can occur after surgery, or after a nonspecific external stimulus. This condition is difficult to diagnose because it often mimics a fulminant infection.
  
  
  METHODS
  We present a case of very significant local presentation of PG after placement of a venous access device. Fifteen days after placement, the patient developed extensive cutaneous ulcers and necrosis in the subclavicular area, which led to the misdiagnosis of infection. The device was removed and the patient was given antibiotics. Because there was no improvement following antibiotic treatment, combined with the worrying and extensive appearance of the skin and extremely intense pain, the diagnosis of PG was made. The patient was immediately treated with high-dose corticosteroids, resulting in rapid improvement of the lesions and relief of pain.
  
  
  CONCLUSIONS
  PG should be considered in cases of extensive, antibiotic-resistant ulceration and treatment with corticosteroids should be initiated. Clinical improvement is usually dramatic, with almost immediate suppression of the pain and arrest of the lesion's progression. Early treatment is the best guarantee for an effective recovery.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Centre Léon Bérard, Lyon - France.
authors.forename: Sophie
authors.initials: S
authors.lastname: La Marca
authors.forename: Gilles
authors.initials: G
authors.lastname: Toussoun
authors.forename: Christophe
authors.initials: C
authors.lastname: Ho Quoc
authors.forename: Henry
authors.initials: H
authors.lastname: Sebban
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Delay
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000188:drug therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D020878:Device Removal; D003951:Diagnostic Errors; D004867:Equipment Design; D005260:Female; D006801:Humans; D011237:Predictive Value of Tests; D017511:Pyoderma Gangrenosum / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome; D019564:Unnecessary Procedures
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents