title: Perianal pyoderma gangrenosum after excision and fulguration of anal condyloma acuminatum.
abstract: BACKGROUND
  Pyoderma gangrenosum (PG) is a rare, 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.
  
  
  METHODS
  We herein present a dramatic presentation of perianal PG four days after routine excision and fulguration of anal condyloma acuminatum. The affected area did not improve with broad spectrum antibiotics or surgical debridement. A diagnosis of PG was made from clinical suspicion and pathology findings, and further confirmed with rapid improvement after starting steroids. Diagnosis of this disease in the postoperative period requires high suspicion when the characteristic ulcerative or bullae lesions are seen diffusely and show minimal improvement with antibiotic treatment or debridement.
  
  
  CONCLUSIONS
  Our case highlights the importance of recognizing this disease in the post-operative period, to allow for early initiation of appropriate treatment and prevent unnecessary surgical debridement of a highly sensitive area. There have been 32 case reports of PG in the colorectal literature, mostly following stoma creation. There is one case report of idiopathic perianal pyoderma gangrenosum with no known prior trauma. To our knowledge there are no previously reported cases of perianal PG after routine elective anorectal surgery.
  
  
  CONCLUSIONS
  This is the first reported case of perianal pyoderma gangrenosum in the post-surgical setting. Increased awareness of pyoderma gangrenosum in the surgical literature will aid in prompt diagnosis and proper medical management of this uncommon postoperative morbidity.
authors.affiliation: Mount Sinai Beth Israel, Department of Surgery, First Avenue at 16th Street, New York, NY 10003, USA. Electronic address: jenniferagnewMD@gmail.com.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Agnew
authors.affiliation: Mount Sinai Beth Israel, Department of Surgery, First Avenue at 16th Street, New York, NY 10003, USA. Electronic address: pstrombom@chpnet.org.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Strombom
authors.affiliation: Mount Sinai Beth Israel, Department of Surgery, First Avenue at 16th Street, New York, NY 10003, USA. Electronic address: cfong@chpnet.org.
authors.forename: Carmen F
authors.initials: CF
authors.lastname: Fong
authors.affiliation: Mount Sinai Beth Israel, Department of Surgery, First Avenue at 16th Street, New York, NY 10003, USA. Electronic address: tikelly@chpnet.org.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Kelly
authors.affiliation: Mount Sinai Beth Israel, Division of Colorectal Surgery, First Avenue at 16th Street, New York, NY 10003, USA. Electronic address: jmartz@chpnet.org.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Martz
keywords: Anorectal surgery; Postoperative wound; Pyoderma gangrenosum