The Importance of Early Diagnosis of Pyoderma Gangrenosum: A Case After Plastic Surgery

Introduction. Pyoderma gangrenosum (PG) is a multifactorial neutrophilic dermatosis of unknown etiology. It can occur in isolation; in association with different inflammatory, autoimmune, or malignant diseases; or as part of various syndromes. Because of its low incidence and the difficulty in distinguishing it from other possible lesions, PG is usually misdiagnosed. As a result, patients may be subjected to unnecessary treatments and surgical interventions that exacerbate the development of PG, as pathergy phenomenon is observed with this skin disorder. Surgical trauma can also lead to the formation of PG with the same mechanism. The occurrence of PG lesions has been reported after plastic surgery as well. In most cases, however, the diagnosis is delayed, resulting in disfigurement, additional surgeries, and extended hospital stay. Case Report. In this article, a case of early detected bilateral PG after reduction mammoplasty in a patient with no personal or family history of autoimmune disorders is presented. Careful examination of the wound and analysis of the clinical picture resulted in the diagnosis of PG. Conclusions. The authors believe that the description of the diagnostic clues considered in this case will aid the plastic surgeon in prompt recognition and management of postoperative PG, with the aim of decreasing patient morbidity and the duration of hospital stay while preventing additional complications.

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Pyoderma gangrenosum – an interdisciplinary approach to the disease

HIGHER SCHOOL’S PULSE ◽

10.5604/01.3001.0012.7978 ◽

2018 ◽

Vol 12 (4) ◽

pp. 61-64

Author(s):

Aleksandra Kapuśniak ◽

Aleksandra Czachor ◽

Grażyna Wąsik

Keyword(s):

Pyoderma Gangrenosum ◽

Rapid Development ◽

Calcineurin Inhibitors ◽

Skin Lesions ◽

Neutrophilic Dermatosis ◽

Unknown Etiology ◽

Neutrophilic Infiltration ◽

Inflammatory Infiltration ◽

Laboratory Findings ◽

Immunological Mechanisms

Pyoderma gangrenosum is a rare dermatosis of unknown etiology. It is classified as being a neutrophilic dermatosis, in which there is inflammatory infiltration consisting primarily of mature polynuclear leukocytes. Its pathogenesis is multifactorial and is thought to involve neutrophilic dysfunction, inflammatory mediators in combination with a genetic predisposition for the disease. Neutrophilic infiltration is observed in new lesions, while necrosis associated with fibrosis and granulomas are seen in chronic lesions, however these findings are not pathognomonic. Pyoderma gangrenosum can occur at any age. However, it most commonly develops in young and middle-aged adults predominantly women between the second and fifth decades of life. Grossly, pyoderma gangrenosum is characterized by skin lesions in the form of rapidly spreading ulcers, with cylindrical edges and necrotic bottoms. These ulcers are painful and crusted but have undermined borders. Pyoderma gangrenosum commonly presents with the rapid development of one or more purulent ulcers with undermined borders on sites of normal or traumatized skin. Pyoderma gangrenosum is often associated with other systemic diseases such as ulcerative colitis, Crohn’s disease, monoclonal gammopathies, IgG or IgA myelomas and tumors of internal organs and hematopoietic system diseases, which supports the immunological mechanisms involved in the pathogenesis of the disease. Of note, neutrophilic infiltration associated with other extracutaneous manifestations and different systemic disorders can co-exist with pyoderma gangrenosum. Despite the recent development of immune modulating drugs in the treatment of skin conditions, steroid therapy still plays a pivotal role. For patients with mild pyoderma gangrenosum, the local application of topical corticosteroids or calcineurin inhibitors can be sufficient. Systemic therapy is necessary in patients with more extensive disease. The role of surgery is controversial, as it is associated with the induction of pathergy. The clinical, histopathologic and laboratory findings in pyoderma gangrenosum are non-specific, and a diagnosis can only be made once other diagnoses have been excluded.

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Pyoderma Gangrenosum Induced by BNT162b2 COVID-19 Vaccine in a Healthy Adult

Vaccines ◽

10.3390/vaccines10010087 ◽

2022 ◽

Vol 10 (1) ◽

pp. 87

Author(s):

Mazin Barry ◽

Abdulaziz AlRajhi ◽

Khaldoon Aljerian

Keyword(s):

Pyoderma Gangrenosum ◽

Messenger Rna ◽

Skin Lesions ◽

Neutrophilic Dermatosis ◽

Unknown Etiology ◽

Rapid Improvement ◽

Inflammatory Infiltration ◽

Cutaneous Manifestations ◽

Wide Scale ◽

Monitoring And Surveillance

(1) Background: Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis of unknown etiology. Coronavirus disease 2019 (COVID-19) vaccines can cause a variety of adverse cutaneous manifestations. PG associated with mRNA vaccines has not previously been described. This case study reports on the first patient to develop PG after receiving BNT162b2. (2) Case Presentation: An otherwise-healthy 27-year-old man developed multiple skin lesions 24 h after receiving the first dose of the messenger RNA-based Pfizer/BioNTech BNT162b2 COVID-19 vaccine. When in hospital, he developed a new painful ulcerative lesion on his right hand. Skin ulcer edge biopsy showed severe epidermal neutrophilic infiltrate with epidermal and dermal edema, underlying superficial dermal necrosis, and characteristic undermining with extensive mixed inflammatory infiltration of the dermis and abscess formation consistent with an ulcer with mixed dermal inflammation compatible with pyoderma gangrenosum. The lesion showed rapid improvement after the initiation of immunosuppressive therapy. (3) Conclusions: PG may be a rare adverse event related to the BNT162b2 vaccine, which could be more frequently encountered with the wide-scale use of mRNA vaccines. The continuous monitoring and surveillance of skin manifestations post-vaccination is essential.

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Laparoscopic versus Open Liver Resection: Differences in Intraoperative and Early Postoperative Outcome among Cirrhotic Patients with Hepatocellular Carcinoma—A Retrospective Observational Study

HPB Surgery ◽

10.1155/2014/871251 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 14

Author(s):

Antonio Siniscalchi ◽

Giorgio Ercolani ◽

Giulia Tarozzi ◽

Lorenzo Gamberini ◽

Lucia Cipolat ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Liver Function ◽

Hospital Stay ◽

Perioperative Complications ◽

Laparoscopic Approach ◽

Postoperative Outcome ◽

Laparoscopic Technique ◽

Surgical Trauma ◽

Cirrhotic Patients

Introduction. Laparoscopic liver resection is considered risky in cirrhotic patients, even if minor surgical trauma of laparoscopy could be useful to prevent deterioration of a compromised liver function. This study aimed to identify the differences in terms of perioperative complications and early outcome in cirrhotic patients undergoing minor hepatic resection for hepatocellular carcinoma with open or laparoscopic technique. Methods. In this retrospective study, 156 cirrhotic patients undergoing liver resection for hepatocellular carcinoma were divided into two groups according to type of surgical approach: laparoscopy (LS group: 23 patients) or laparotomy (LT group: 133 patients). Perioperative data, mortality, and length of hospital stay were recorded. Results. Groups were matched for type of resection, median number of nodules, and median diameter of largest lesions. Groups were also homogeneous for preoperative liver and renal function tests. Intraoperative haemoglobin decrease and transfusions of red blood cells and fresh frozen plasma were significantly lower in LS group. MELD score lasted stable after laparoscopic resection, while it increased in laparotomic group. Postoperative liver and renal failure and mortality were all lower in LS group. Conclusions. Lower morbidity and mortality, maintenance of liver function, and shorter hospital stay suggest the safety and benefit of laparoscopic approach.

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A Rare Case of Pyoderma Gangrenosum in a HIV Positive Patient

Asian Journal of Medical Sciences ◽

10.3126/ajms.v2i2.4029 ◽

2011 ◽

Vol 2 (2) ◽

pp. 128-130

Author(s):

Eswari Loganathan ◽

Asima Banu

Keyword(s):

Pyoderma Gangrenosum ◽

Rare Case ◽

Positive Patient ◽

Neutrophilic Dermatosis ◽

Hiv Positive ◽

Medical Sciences ◽

First Line ◽

Hodgkins Lymphoma ◽

Lymphoid Malignancies ◽

Non Hodgkins Lymphoma

HIV infection can lead to varied spectrum of associated disease conditions. Pyoderma gangrenosum is a neutrophilic dermatosis that may be associated with myeloid malignancies. Less information is available about the association of pyoderma gangrenosum with lymphoid malignancies. We report a rare case of pyoderma gangrenosum in association with Non hodgkins lymphoma(NHL) of diffuse large B cell type. In this case the lesion which showed NHL features occurred in the perianal region, coexisting with pyoderma gangrenosum lesions in the perianal, lower limb and abdominal region. Another interesting feature is the occurrence of both these conditions in a HIV-positive patient with severe immunologic failure to first line antiretroviral therapy contributing to the refractoriness to treatment. Key Words: HIV; pyoderma gangrenosum; Non Hodgkins Lymphoma DOI: http://dx.doi.org/10.3126/ajms.v2i2.4029 Asian Journal of Medical Sciences 2 (2011) 128-130

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Pathophysiological aspects as the object of the treatment tactics in acute pancreatitis (review)

Inter Collegas ◽

10.35339/ic.8.2.87-94 ◽

2021 ◽

Vol 8 (2) ◽

pp. 87-94

Author(s):

Igor Kryvoruchko ◽

Anastasiya Drozdova ◽

Nataliya Goncharova

Keyword(s):

Acute Pancreatitis ◽

Minimally Invasive ◽

Postoperative Period ◽

Surgical Trauma ◽

Fast Track Surgery ◽

Surgical Interventions ◽

Minimally Invasive Surgical ◽

Treatment Measures ◽

Mechanisms Of Development ◽

Adequate Management

The review presents a modern view on the features of the course and treatment of acute pancreatitis, based on a cascade of pathophysiological mechanisms of this disease. A number of concepts of development and course of acute pancreatitis on the basis of randomized prospective and retrospective researches devoted to this problem are considered. Attention is paid to the mechanisms of development of organ failure in acute pancreatitis. In accordance with the above, the main positions of treatment measures for acute pancreatitis, which are based on the principles of tactics "step-up approach" were highlighted. Among them, attention is focused on the features of the conservative treatment program, minimally invasive surgical interventions, as well as the management of the postoperative period of patients. Minimally invasive surgical interventions perform the main tasks of surgical treatment in acute pancreatitis, but significantly reduce surgical trauma compared to "open" methods. Adequate management of the postoperative period of patients is carried out through the implementation of protocols "fast-track surgery".

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Abstract 11053: The Association Between the Systemic Immune-Inflammation Index with the Duration of Cardiopulmonary Bypass in Cardiac Surgery: A Retrospective, Single-Center Study

Circulation ◽

10.1161/circ.144.suppl_2.11053 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Yanan Hu ◽

Yi Liu ◽

Yongzhe Liu ◽

Hui Chen ◽

Wei Jiang ◽

...

Keyword(s):

Cardiac Surgery ◽

Inflammatory Response ◽

Hospital Stay ◽

Time Course ◽

Ischemia Reperfusion ◽

Systemic Inflammatory Response ◽

Surgical Trauma ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Immune Inflammation

Introduction: Systemic inflammatory response evoked by cardiac surgery involving a cardio-pulmonary bypass (CPB) in combination of surgical trauma, ischemia/reperfusion injury, hypothermia, and endotoxin release contributed to the postoperative morbidity and mortality. This study aimed to explore the potential of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) as novel markers to evaluate and predict the adverse clinical outcomes after longer CPB time in cardiac surgery. Methods: Patients who underwent cardiac surgery with or without CPB were allocated into two groups, CPB group (n=11) and N-CPB group (n=21). The time course of NLR, PLR, SII, and C-reactive protein (CPR) were analyzed at preoperative day 1 and postoperative day 1, 3, and 7. The baseline and postoperative parameters, the ICU and hospital stay were recorded. Results: There were no differences of baseline parameters between groups. The level of NLR, PLR, SII, and CPR at postoperative day 1 was higher than that in the preoperative day 1 in both groups (p < 0.01). The level of NLR, SII and CPR at postoperative day 3 was higher than that in the preoperative day 1 in both groups (p < 0.05). The NLR and SII at postoperative day 3 were higher in CPB group than that in N-CPB group (p < 0.05). The ICU and hospital stay was longer in CPB group than N-CPB group (p < 0.05). Conclusions: The longer duration of CPB time induced higher systemic inflammatory response characterized by higher level of NLR, PLR and SII. The SII predicted the poor outcome after longer CPB. The peak of systemic inflammatory response occurred on the third day after cardiac surgery.

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Applying Intravenous Immunoglobulin and Negative-Pressure Wound Therapy to Treat Refractory Pyoderma Gangrenosum: A Case Report

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620940459 ◽

2020 ◽

pp. 153473462094045

Author(s):

Shi-Ying Jin ◽

Mei Chen ◽

Feng-Yuan Wang ◽

Fei Wang

Keyword(s):

Intravenous Immunoglobulin ◽

Pyoderma Gangrenosum ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Lower Leg ◽

Neutrophilic Dermatosis ◽

Wound Therapy ◽

Systemic Corticosteroids ◽

Painful Ulcer ◽

The Right

Pyoderma gangrenosum (PG) is a rare chronic neutrophilic dermatosis that causes undermining ulcers. Unfortunately, standardization of PG treatment remains a challenge. In this article, we describe a case in which a 69-year-old man presented with a painful ulcer on the right lower leg. The diagnosis of PG was made after excluding other diseases. He had a history of PG on his left lower leg 2 years earlier and was cured by the treatment of systemic corticosteroids and cyclosporin A for 43 days. However, such a treatment was not effective this time. Hence, we applied intravenous immunoglobulin and negative-pressure wound therapy, and the patient was cured. Altogether, this case supports the use of intravenous immunoglobulin as an effective adjuvant for refractory PG, and indicates negative-pressure wound therapy as a treatment option to advance ulcer healing under adequate immunosuppression.

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Clinical outcome of endoscopic treatment for symptomatic sterile walled-off necrosis

Endoscopy ◽

10.1055/a-1198-7501 ◽

2020 ◽

Author(s):

Lotte Boxhoorn ◽

Jeska A. Fritzsche ◽

Paul Fockens ◽

Jeanin E. van Hooft ◽

Pieter J. F. de Jonge ◽

...

Keyword(s):

Hospital Stay ◽

Clinical Success ◽

Necrotizing Pancreatitis ◽

Outlet Obstruction ◽

Case Series ◽

Open Label ◽

Surgical Interventions ◽

Persistent Symptoms ◽

Walled Off Necrosis

Background The majority of patients with symptomatic sterile walled-off necrosis (WON) can be treated conservatively. Although endoscopic transluminal drainage (ETD) is often performed in cases of persistent symptoms, post-procedural iatrogenic infection may occur. This study aimed to evaluate clinical outcomes after ETD of symptomatic sterile WON. Methods This was a retrospective, multicenter, open-label case series of 56 patients with necrotizing pancreatitis who underwent ETD for symptomatic sterile WON between July 2001 and August 2018 at two tertiary referral hospitals. Primary end point was clinically relevant post-procedural iatrogenic infection, defined as need for endoscopic transluminal necrosectomy. Secondary end points included mortality, total number of interventions, hospital stay, and resolution of symptoms at 1-year follow-up. Results ETD of sterile WON was performed in 56 patients (median age 55 years, 57 % male), who presented with abdominal pain (71 %), gastric outlet obstruction (45 %), jaundice (20 %), and failure to thrive (27 %). A total of 41 patients (73 %) developed clinically relevant post-procedural iatrogenic infection, resulting in a median of 3 (interquartile range [IQR] 2 – 4) endoscopic, radiological, and/or surgical interventions. Mortality rate was 2 %. Median total hospital stay was 12 days (IQR 6 – 17). Resolution of symptoms was reported in 40 of 46 patients (87 %) for whom long-term follow-up data were available (median follow-up 13 months, IQR 6 – 29). Conclusions ETD of symptomatic sterile WON resulted in high clinical success. Nonetheless, the majority of patients required additional reinterventions for clinically relevant post-procedural iatrogenic infection.

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