title: Pyoderma gangrenosum: A clinician's nightmare.
abstract: Pyoderma gangrenosum (PG) is a rare disease and that affecting specifically the sole of the foot, is even rarer. Here, we report the case of a 54-year-old female admitted with a painful ulcer on the sole of the right foot which was initially treated with empirical antibiotics and debridement. The disease was found to spread rapidly after each debridement. The culture reports were negative; rheumatology workup and Doppler study were within normal limits. A clinical suspicion of PG was made and was confirmed with tissue biopsy. She was started on oral steroids following which she dramatically improved. Thus, when a patient presents with a rapidly expanding painful ulcer in a vascular limb that is refractory to antibiotic treatment and exacerbating on debridement, it is imperative to consider the possibility of PG.
authors.affiliation: Department of Family Medicine, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India.
authors.forename: Bindhu
authors.initials: B
authors.lastname: Bhaskaran
authors.affiliation: Department of General Surgery, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India.
authors.forename: Mittu John
authors.initials: MJ
authors.lastname: Mathew
authors.affiliation: Department of General Surgery, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India.
authors.forename: K N
authors.initials: KN
authors.lastname: Vijayan
authors.affiliation: Department of Dermatology and Cosmetology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India.
authors.forename: Asha
authors.initials: A
authors.lastname: Zacharia
keywords: Pyoderma gangrenosum; spreading; ulcer