title: Pyoderma gangrenosum after cardiac surgery masquerading as a fulminant sternal wound infection.
abstract: BACKGROUND
  Pyoderma gangrenosum (PG) is a rare, ulcerative inflammatory skin pathology frequently associated with systemic inflammatory disease. While rare after surgery, recognition of this disease in the post-surgical setting is important as it can mimic wound infection. There have been ten case reports to date of PG occurring immediately after cardiac surgery, with all of them presenting within the first week post-operatively.
  
  
  METHODS
  We herein present a delayed and dramatic presentation of PG nine days after mitral valve replacement and repair of patent foramen ovale, two days after being discharged with a seemingly normal healing wound. Diagnosis of this disease in the postoperative period requires high suspicion when the characteristic ulcerative lesions are seen diffusely in all surgical wounds and show minimal improvement with antibiotic treatment or debridement.
  
  
  CONCLUSIONS
  Our case highlights the importance of recognizing this disease in the postoperative period, even in a delayed presentation and initially limited to one of the surgical sites. This case calls for an awareness of this disease entity amongst cardiac surgeons as well as intensivists.
authors.affiliation: Beth Israel Medical Center, Department of Surgery, United States.
authors.forename: Kei
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Beth Israel Medical Center, Division of Plastic Surgery, United States.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sieczka
authors.affiliation: Beth Israel Medical Center, Division of Cardiac Surgery, First Avenue at 16th Street, New York, NY 10003, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Tranbaugh
authors.affiliation: Beth Israel Medical Center, Division of Cardiac Surgery, First Avenue at 16th Street, New York, NY 10003, United States. Electronic address: DHoffman@chpnet.org.
authors.forename: Darryl
authors.initials: D
authors.lastname: Hoffman
keywords: Postoperative infection; Pyoderma gangrenosum