Pyoderma Gangrenosum Rare Parietal Complication after Colorectal Surgery
A. Miron, C. Giulea, I. Tudose, D. Petrache, C. GiurcaneanuClinical case, no. 2, 2014
Pyoderma gangrenosum (PG) is a rare chronic destructiveinflammatory skin disease characterized by the presence ofnodules and pustules with progressively enlarging ulcers and orcutaneous necrosis. In most cases PG is idiopathic, butsometimes it is associated with conditions that often havevasculitis, such as gammapathies, inflammatory bowel diseasesor chronic arthritis. PG is neither infectious nor gangrenous,but some authors advanced the theory that an infectiousetiology (streptococci and staphylococci) could be incriminated.Recently, there are reports in the literature stating that PG is acondition that can occur after local trauma, especially surgery.We report the case of a 73 year old man who presented himselfto the Surgery Department with rectal adenocarcinoma andpostoperatively developed well-demarcated, vegetative plaques,ranging from 2 to 5 cm in diameter, with central ulcerationassociated with necrosis and a purulent secretion, delimitated byraised, dusky erythematous borders. These lesions were locatedon the abdomen and it is important to mention that the injuriesoccurred at the site of surgical stitches used during the rectumamputation surgery, with no other anatomical locations,pruritus or pain associated. We performed two differenthistopathological examinations for this patient, regarding therectal specimens and the cutaneous specimen. The firstexaminations revealed rectal adenocarcinoma and nonspecificcolitis. The second examination was concluded with thediagnosis of pyoderma gangrenosum, the ulcerative stage. Thepatient had a very good clinical response to systemic steroidtherapy.
