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Teknős D, Simsay L, Váradi G, Trávnyik S, Bíró E, Grics L, Lellei I, El-Meouch H. [Pyoderma gangrenosum of the breast – Case report]. Magy Seb 2022; 75:211-213. [PMID: 36006767 DOI: 10.1556/1046.2022.30001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
Pyoderma gangrenosum (PG) of the breast is a rare, ulcerative disease of rapid onset normally associated with systemic disorders and triggered by surgery or trauma. Early diagnosis and appropriate treatment of this disease pose a real challenge. We present a case of a PG of the breast in a patient with associated diabetes mellitus, with minor triggering injury. Our patient's condition was diagnosed and treated as an infected breast ulcer; after getting the correct diagnosis we treated her with systemic steroids and finally (at the patient's request) with breast ablation.
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Affiliation(s)
- Dániel Teknős
- 1 Jávorszky Ödön Kórház, Sebészet, Vác, Magyarország
| | - Laura Simsay
- 1 Jávorszky Ödön Kórház, Sebészet, Vác, Magyarország
| | - Gábor Váradi
- 1 Jávorszky Ödön Kórház, Sebészet, Vác, Magyarország
| | | | - Erik Bíró
- 1 Jávorszky Ödön Kórház, Sebészet, Vác, Magyarország
| | - László Grics
- 1 Jávorszky Ödön Kórház, Sebészet, Vác, Magyarország
| | - Ilona Lellei
- 2 Jávorszky Ödön Kórház, Pathológiai Osztály, Vác, Magyarország
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Gündüz K, Gülbaşaran F, Hasdemir PS, Temiz P, Inanır I. Successful treatment of severe refractory post-cesarean pyoderma gangrenosum with intravenous immunoglobulin. Dermatol Ther 2020; 33:e14121. [PMID: 32743854 DOI: 10.1111/dth.14121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by rapidly progressing necrolytic ulceration of the skin. Proper treatment is crucial since it can result in devastating consequences. First-line treatments include systemic corticosteroids or cyclosporine. However, no standardized treatment regimens for refractory cases exist and treatment outcomes are affected by underlying conditions. PG after cesarean section, which is believed to occur in association with underlying pregnancy- and parturition-related immune changes, is extremely rare, and all reported cases in the literature have been successfully treated with systemic or topical corticosteroids. We report a case of a 32-year-old patient with severe PG occurring on her cesarean scar 3 days after the cesarean delivery. Treatment with systemic corticosteroids and first-line immunomodulatory agents resulted in insufficient response and serious complications. Intravenous immunoglobulin (IVIG) was then initiated, and a rapid clinical response was seen. Corticosteroid dose was gradually decreased and ceased. IVIG infusion was continued for 3 months until complete recovery. Reactivation was not observed in a 1-year follow-up period. Due to its cost, IVIG infusion is less suitable as a first-line agent. However, IVIG may be an important therapeutic option in resistant postpartum PG, in which first-line agents have failed or led to complications.
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Affiliation(s)
- Kamer Gündüz
- Medical Faculty, Department of Dermatology, Celal Bayar University, Manisa, Turkey
| | - Fatmagül Gülbaşaran
- Medical Faculty, Department of Dermatology, Celal Bayar University, Manisa, Turkey.,Department of Dermatology, Salihli State Hospital, Manisa, Turkey
| | - Pınar Solmaz Hasdemir
- Medical Faculty, Department of Obstetrics and Gynecology, Celal Bayar University, Manisa, Turkey
| | - Peyker Temiz
- Medical Faculty, Department of Pathology, Celal Bayar University, Manisa, Turkey
| | - Işıl Inanır
- Medical Faculty, Department of Dermatology, Celal Bayar University, Manisa, Turkey
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3
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Cabañas Weisz LM, Vicario Elorduy E, García Gutiérrez JJ. "Pyoderma gangrenosum of the breast: A challenging diagnosis". Breast J 2020; 26:2188-2193. [PMID: 32713082 DOI: 10.1111/tbj.13984] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 11/29/2022]
Abstract
Pyoderma gangrenosum (PG) of the breast is a rare, ulcerative disease of rapid onset normally associated with systemic disorders and triggered by surgery or trauma. Pyoderma gangrenosum poses a diagnostic challenge. Early diagnosis and appropriate treatment are essential to minimize morbidity and sequelae. We performed a retrospective review of all breast PG cases admitted to Cruces University Hospital over a 5-year (2015-2019) period. Medical history, clinical course, and management strategies were assessed. Three patients were analyzed. None of them had previous surgery. No definitive etiology was identified in one case, and the other two were probably biopsy-driven. Histological findings were reported as nonspecific. Similar skin lesions elsewhere on the body and resistance to wide-spectrum antibiotic therapy were observed. These features raised awareness on the diagnosis of PG. Ulcerations healed completely within 2 months following treatment with Cyclosporine A or corticosteroid therapy. A complicated late-diagnosis case that presented with advanced breast and forearm necrosis was managed with steroids followed by trans-forearm amputation and mastectomy. The breast is an unusual site for PG, but this differential diagnosis should be considered in the presence of breast ulceration. In patients with a strong clinical and histological PG suspicion, we suggest early management with systemic corticosteroids and immunosuppressive therapy prior to any surgical debridement to minimize morbidity and poor esthetic outcomes.
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Aytekin S, Süel S, Güneş P. The Bork-Baykal phenomenon as sparing of areola and nipple is a clue for the diagnosis of breast pyoderma gangrenosum. J Eur Acad Dermatol Venereol 2020; 34:e608-e609. [PMID: 32302452 DOI: 10.1111/jdv.16487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 11/27/2022]
Affiliation(s)
- S Aytekin
- Department of Dermatology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - S Süel
- Department of Dermatology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - P Güneş
- Department of Pathology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
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Pellegrino SA, Cham A, Pitcher M. Pyoderma gangrenosum of the breast 17 years after breast cancer treatment. BMJ Case Rep 2020; 13:13/3/e232983. [PMID: 32193178 DOI: 10.1136/bcr-2019-232983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We present a case of pyoderma gangrenosum (PG) affecting the breast of a 74-year-old woman, with a history of breast cancer treated with breast conserving surgery and adjuvant radiotherapy 17 years prior. She presented to the hospital with worsening breast ulceration, after a punch biopsy was performed at the site. She had surrounding cellulitis and concurrent infection to that breast which required antibiotics. The ulceration persisted even after treatment, and incisional biopsies of the area of ulceration confirmed the diagnosis of PG. Her condition was managed effectively with the use of immunosuppressive therapy, and she continued to display a good clinical response 2 months post discharge from the hospital.
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Affiliation(s)
| | - Alvin Cham
- Breast and General Surgery, Western Health, Melbourne, Victoria, Australia
| | - Meron Pitcher
- Breast and General Surgery, Western Health, Melbourne, Victoria, Australia
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Pyoderma gangrenosum with pathergy: A potentially significant complication following breast reconstruction. J Plast Reconstr Aesthet Surg 2017; 70:884-892. [PMID: 28476284 DOI: 10.1016/j.bjps.2017.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/27/2017] [Accepted: 03/29/2017] [Indexed: 11/23/2022]
Abstract
The failure of postoperative surgical site infection to resolve after appropriate antibiotic therapy should alert the clinician to other diagnoses. Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis that is typically characterized by necrotizing ulceration. PG can be exacerbated by minor trauma leading to exaggerated skin injury, a condition known as pathergy. We present a case series of PG arising after immediate reconstruction for breast oncological surgery from 1st January 2006 to 1st September 2014. 395 immediate breast reconstructions were performed in 335 patients. Three cases of post-surgical PG were identified (0.9%), all in the setting of mastectomy for breast cancer. Two cases underwent immediate reconstruction with pedicled transverse rectus abdominus myocutaneous flaps, and one underwent submuscular expander insertion. A mean delay of 6.3 days was observed from first presentation of symptoms to diagnosis of PG. Immunosuppressants commonly used included methylprednisolone, prednisone, and ciclosporin, with good success at halting disease progress. Significant scarring affected all three women. Once the disease was deemed quiescent, intravenous immunoglobulin used in the perioperative period for further surgical procedures provided favorable results. A diagnostic algorithm is suggested to guide surgeons in investigations and management when post-surgical PG is suspected.
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Marinopoulos S, Theofanakis C, Zacharouli T, Sotiropoulou M, Dimitrakakis C. Pyoderma Gangrenosum of the breast: A case report study. Int J Surg Case Rep 2017; 31:203-205. [PMID: 28187399 PMCID: PMC5300301 DOI: 10.1016/j.ijscr.2017.01.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/15/2017] [Accepted: 01/16/2017] [Indexed: 11/25/2022] Open
Abstract
Pyoderma gangrenosum of the breast as a de novo presentation is rare and mostly associated with underlying autoimmune or hematologic disorders. It is also associated with breast cosmetic surgery or previous cesarian section. In this study, we report a case of pyoderma gangrenosum of the breast in a patient with no prior medical history and no surgeries. Treatment of pyoderma gangrenosum of the breast consists of systematic corticosterod use, while surgical debridement has a beneficiary effect.
Introduction Pyoderma gangrenosum (PG) of the breast is a rare and rapidly spreading disease, which usually co-exists with severe underlying systemic conditions. PG often presents secondary to breast surgery with skin lesions and signs of infection, even though it is a non-infectious, necrotizing dermatological entity. Presentation of case We present a case of de novo unilateral breast PG in 37-year-old woman, with a clear medical history whatsoever. The patient was treated with corticosteroids and, in a two-month follow up, presents with nearly no signs of PG. Discussion PG of the breast presents with atypical clinical signs and is characterized by an exclusion-based diagnosis. It often mimics inflammation but is resistant to antibiotics. Conclusion The optimal treatment for PG is systemic use of corticosteroids and surgical debridement of the necrotic tissue, while the timely onset of the therapeutic approach is of outmost importance.
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Affiliation(s)
- Spyridon Marinopoulos
- Breast Unit, 1st Obstetrics and Gynecology Department, Athens University Medical School, Alexandra Hospital, Greece.
| | - Charalampos Theofanakis
- Breast Unit, 1st Obstetrics and Gynecology Department, Athens University Medical School, Alexandra Hospital, Greece
| | - Theoni Zacharouli
- Breast Unit, 1st Obstetrics and Gynecology Department, Athens University Medical School, Alexandra Hospital, Greece
| | | | - Constantine Dimitrakakis
- Breast Unit, 1st Obstetrics and Gynecology Department, Athens University Medical School, Alexandra Hospital, Greece
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Sterling C, Crane GM, Al-Hariri J, Shanbhag S. Double Jeopardy: Autoimmune Myelofibrosis with Pyoderma Gangrenosum. Am J Med 2017; 130:e1-e4. [PMID: 27401951 DOI: 10.1016/j.amjmed.2016.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Cole Sterling
- Johns Hopkins University School of Medicine, Baltimore, Md
| | - Genevieve M Crane
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Jihad Al-Hariri
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Satish Shanbhag
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
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Juhász MLW, Maman DY, Levin JM, Marmur ES. Pyoderma gangrenosum of the breast in a patient with a history of silicone augmentation mastopexy and suction-assisted lipectomy of the trunk. JAAD Case Rep 2015; 1:329-32. [PMID: 27051770 PMCID: PMC4809383 DOI: 10.1016/j.jdcr.2015.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Margit L W Juhász
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel Y Maman
- 5th Avenue Millennium Aesthetic Surgery, New York, New York
| | | | - Ellen S Marmur
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; Marmur Medical, New York, New York
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Post Reconstruction Breast Pyoderma Gangrenosum: Early Recognition and Prosthesis Salvage. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e434. [PMID: 26180735 PMCID: PMC4494504 DOI: 10.1097/gox.0000000000000412] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/08/2015] [Indexed: 01/01/2023]
Abstract
We report 3 cases of breast pyoderma gangrenosum in patients undergoing total mastectomy with immediate reconstruction. All three received systemic corticosteroid treatment, resulting in resolution of symptoms. As experience grew, early diagnosis in the third patient helped prosthesis salvage and timely return to the original course of reconstruction. This represents the first report of prosthesis salvage from post breast reconstruction pyoderma gangrenosum, and it demonstrates that implant removal is not always necessary during management of this rare condition.
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Pyoderma gangrenosum with monoclonal IgA gammopathy and pulmonary tuberculosis. Illustrative case and review. Postepy Dermatol Alergol 2015; 32:137-41. [PMID: 26015785 PMCID: PMC4436233 DOI: 10.5114/pdia.2014.40974] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 01/06/2014] [Accepted: 01/13/2014] [Indexed: 02/07/2023] Open
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Zuo KJ, Fung E, Tredget EE, Lin AN. A systematic review of post-surgical pyoderma gangrenosum: Identification of risk factors and proposed management strategy. J Plast Reconstr Aesthet Surg 2015; 68:295-303. [DOI: 10.1016/j.bjps.2014.12.036] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/25/2014] [Accepted: 12/06/2014] [Indexed: 01/17/2023]
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Doren EL, Aya-ay ML. Pyoderma gangrenosum following breast reduction: treatment with topical tacrolimus and steroids. Aesthet Surg J 2014; 34:394-9. [PMID: 24448967 DOI: 10.1177/1090820x13520448] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Pyoderma gangrenosum (PG) is a rare, noninfectious, inflammatory dermatosis usually associated with autoimmune disorders. Wounds may mimic a necrotizing infection, and the diagnosis is usually made after antibiotic therapy fails. Debridement may cause even larger wounds because of pathergy, so PG treatment consists of corticosteroids and local wound care. Pyoderma gangrenosum can be a devastating complication of breast and aesthetic surgery. We describe a case of PG following unilateral breast reduction that resulted in systemic inflammatory response; after treatment with prednisone and topical tacrolimus, the PG was resolved. The application of topical tacrolimus may reduce the need for prolonged corticosteroids. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Erin Louise Doren
- Dr Doren is an Integrated Plastic Surgery Resident in the Department of Surgery, Division of Plastic Surgery, University of South Florida, Tampa, Florida
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15
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Pyoderma gangrenosum after breast reduction: A rare complication. J Plast Reconstr Aesthet Surg 2013; 66:e336-7. [DOI: 10.1016/j.bjps.2013.06.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 06/15/2013] [Accepted: 06/18/2013] [Indexed: 12/15/2022]
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Sinnya S, Hamza S. Pyoderma gangrenosum of the breast treated with intravenous immunoglobulin. J Dermatol Case Rep 2013; 7:64-8. [PMID: 23858345 DOI: 10.3315/jdcr.2013.1140] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 03/27/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pyoderma gangrenosum is a rare neutrophilic dermatosis which leads to necrotic and painful skin ulceration. PG of the breast is extremely rare with 32 documented cases in the current literature. Delay in diagnosis worsens scarring as the ulcers are rapidly expanding, painful and usually slow to heal. CASE PRESENTATION We present a case of pyoderma gangrenosum of the breast in a patient with associated rheumatoid arthritis which was initially diagnosed as an infected breast ulcer and later successfully treated with systemic steroids and intravenous immunoglobulin (IVIG). CONCLUSION Even though PG of the breast has been gaining increased recognition over the past two decades, this has been more common in the post-surgical setting. This case highlights the need to consider PG as a differential diagnosis when faced with unsual cases of breast ulceration and the importance of multidisplinary approach for effective treatment of this condition.
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Affiliation(s)
- Sudipta Sinnya
- Princess Alexandra Hospital, 199 Ipswich Road Woolloongabba, Queensland 4102, Australia
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Andrisani G, Guidi L, Papa A, Potenza AE, Cervelli D, Armuzzi A. A case of pyoderma gangrenosum with ulcerative colitis treated with combined approach: infliximab and surgery. J Crohns Colitis 2013; 7:421-6. [PMID: 22889645 DOI: 10.1016/j.crohns.2012.07.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 07/21/2012] [Accepted: 07/21/2012] [Indexed: 02/08/2023]
Abstract
Pyoderma gangrenosum (PG) is an ulcerating noninfectious disease of the skin seen in 1-2% of patients with inflammatory bowel disease (IBD). The pathogenesis of PG has yet to be determined, but may be related to abnormal T cell responses and the production of TNF-α, a pathway also involved in IBD pathogenesis. Infliximab, a chimeric monoclonal antibody to TNF-α, is used to treat moderate to severe IBD and several case reports and studies suggest the efficacy of infliximab in the treatment of PG. The surgical approach to PG is reserved to a few selected cases. We report here the case of a patient with ulcerative colitis (UC) and PG localized on the left breast, treated with a simultaneous combined medical and surgical approach.
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Affiliation(s)
- G Andrisani
- Internal Medicine and Gastroenterology Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
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Grillo MA, Cavalheiro TT, da Silva Mulazani M, Rocha JLL, Semchechen D, da Cunha CA. Postsurgical pyoderma gangrenosum complicating reduction mammaplasty. Aesthetic Plast Surg 2012; 36:1347-52. [PMID: 23052384 DOI: 10.1007/s00266-012-9981-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 07/17/2012] [Indexed: 11/30/2022]
Abstract
UNLABELLED Reduction mammaplasty is one of the most common surgeries performed by plastic surgeons. It relieves back and neck pain and improves the aesthetic contour of the ptotic breast. Postsurgical pyoderma gangrenosum (PSPG) is an unusual inflammatory disorder leading to rapidly progressive skin necrosis that can occur after any surgical procedure. The skin lesions have the characteristic appearance of ulcers with a purple-colored border and erythematous halo. Clinically, the patient has a low fever and severe local pain. In the majority of cases this disease is misdiagnosed as severe infection leading to improper debridement, exacerbating the problem. The mainstay of therapy for PSPG is still nonoperative and focuses on immunosuppressive medications and local wound care, which allows healing in the majority of the cases. It is important for plastic surgeons and infectologists to be cognizant of this entity, as a delay in diagnosis and management can be life-threatening and lead to considerable tissue loss and disfigurement of the breast. The authors report a case of reduction mammaplasty complicated with PSPG and its treatment. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Marcos Artigas Grillo
- Clínica de Cirurgia Plástica Dr. Marcos Grillo, Avenida Sete de Setembro, Curitiba, PR, 4848, Brazil.
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Kasper K, Manger B, Junger A, Reichert B, Sievers R, Herdtle S. [Pyoderma gangrenosum following AICD implantation: differential diagnosis to necrotizing fasciitis]. Anaesthesist 2012; 61:47-51. [PMID: 22249404 DOI: 10.1007/s00101-011-1949-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 09/19/2011] [Indexed: 11/24/2022]
Abstract
Pyoderma gangrenosum is rarely seen in the surgical disciplines. In the described case the patient was initially diagnosed with necrotizing fasciitis and admitted to the intensive care unit suffering from septic shock. The automated implantable cardioverter defibrillator (AICD), the suspected focus for infection, had already been removed. Following weeks of broad spectrum antibiotics and wound debridement without clinical improvement the alternative diagnosis of pyoderma gangrenosum was reached. Consequently the patient was treated with immunosuppressive therapy and his condition improved rapidly such that he was ultimately discharged to rehabilitation.
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Affiliation(s)
- K Kasper
- Klinik für Anästhesiologie und Intensivmedizin, Klinikum Nürnberg, Nürnberg, Deutschland.
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Leppard WM, Reynolds MF, Schimpf DK, Baker MK, Barbour JR. Pyoderma Gangrenosum of the Breast after Bilateral Simple Mastectomies for Ductal Carcinoma In Situ. Am Surg 2011. [DOI: 10.1177/000313481107700707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- William M. Leppard
- Department of Surgery Division of Plastic and Reconstructive Surgery Medical University of South Carolina Charleston, South Carolina
| | - Michael F. Reynolds
- Department of Surgery Division of Plastic and Reconstructive Surgery Medical University of South Carolina Charleston, South Carolina
| | - Dennis K. Schimpf
- Department of Surgery Division of Plastic and Reconstructive Surgery Medical University of South Carolina Charleston, South Carolina
| | - Megan K. Baker
- Department of Surgery Division of Plastic and Reconstructive Surgery Medical University of South Carolina Charleston, South Carolina
| | - John R. Barbour
- Department of Surgery Division of Plastic and Reconstructive Surgery Medical University of South Carolina Charleston, South Carolina
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