SHM Converge Scientific Abstract ePoster Gallery-Differentiating Pyoderma Gangrenosum From Cutaneous Abscesses: Implications for Inpatient Management

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A 9-year-old girl was hospitalized for a worsening, purulent-appearing left shin wound initially treated as a skin infection. Ultrasound suggested a small complex collection, so incision and drainage was performed and broad-spectrum antibiotics were started. However, her wound worsened, she developed persistent fever, and blood and wound cultures stayed negative. Further review revealed a significant history of a NOD2-associated autoinflammatory disease, previously treated with anakinra, with past symptoms including fever, diarrhea, arthritis, and mouth ulcers.<br /><br />She was transferred to a tertiary center for multidisciplinary evaluation. Laboratory evidence of systemic inflammation, anemia, and elevated fecal calprotectin raised concern for an underlying inflammatory disorder. She improved after treatment with methylprednisolone and anakinra. Endoscopic evaluation showed no upper GI disease, but colonoscopy demonstrated inflammatory changes consistent with active inflammatory bowel disease. She then received infliximab induction and methotrexate and was discharged on hospital day 21 with close follow-up. Her wound fully resolved after discharge.<br /><br />This case highlights pyoderma gangrenosum (PG), a non-infectious neutrophilic skin disease that can resemble an abscess or infected ulcer. PG is frequently associated with systemic disease, especially inflammatory bowel disease, and its management should include investigation for an underlying condition. Because debridement and biopsy can worsen inflammation, recognizing PG early is important. Severe cases may respond to systemic corticosteroids and biologic therapy such as infliximab.

Asset Subtitle

Christopher K. Wong

Meta Tag

Author List Christopher K. Wong, Kazi Haque, Raymond Parlar-Chun

Category Clinical Vignettes

Concept Pyoderma Gangrenosum

Concept Infectious Cutaneous Abscess

Concept Neutrophilic Dermatosis

Concept Cutaneous Ulcer

Concept Inflammatory Bowel Disease

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Christopher K. Wong

Track Pediatric

Keywords

pyoderma gangrenosum

inflammatory bowel disease

NOD2-associated autoinflammatory disease

pediatric case

skin ulcer

neutrophilic dermatosis

anakinra

infliximab

methylprednisolone

colonoscopy

Pyoderma Gangrenosum

Infectious Cutaneous Abscess

Neutrophilic Dermatosis

Cutaneous Ulcer

Inflammatory Bowel Disease