SHM Converge Scientific Abstract ePoster Gallery-The Deceptive Wound: Post Surgical Pyoderma Gangrenosum Masquerading as Infection

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This case report describes a 64-year-old woman who developed worsening breast pain, fever, and purulent drainage five days after bilateral reduction mammoplasty for macromastia. Because the presentation suggested a surgical site infection, she underwent operative washout and debridement and was treated with broad-spectrum antibiotics, including piperacillin-tazobactam and linezolid. Despite this, her wounds worsened with progressive ulceration and exudate. Repeat debridement and tissue cultures were again negative, and she still did not improve on antibiotics.<br /><br />Histopathology showed suppurative inflammation with fat necrosis. Given the combination of nonhealing ulcers, negative cultures, and failure to respond to antimicrobial therapy, postsurgical pyoderma gangrenosum (PSPG) was suspected. Dermatology was consulted, and after topical corticosteroids were started, the patient stabilized. Systemic prednisone 60 mg daily then led to marked clinical improvement, and she was discharged in stable condition.<br /><br />The report emphasizes that PSPG is often mistaken for infection, abscess, or necrotizing fasciitis, which can lead to unnecessary antibiotics and repeated surgical debridement. Diagnosis is by exclusion and is supported by histopathology showing neutrophilic inflammation without evidence of infection. Early recognition is important because surgical trauma can worsen lesions through pathergy.<br /><br />Treatment is centered on immunosuppression, with systemic corticosteroids and cyclosporine considered first-line options. Biologic agents, especially TNF-α inhibitors, may be used for severe or refractory cases. The key lesson from this case is that clinicians should maintain a high index of suspicion for PG when postoperative wounds deteriorate despite appropriate infection-directed therapy.

Asset Subtitle

Nagendra Babu Indurti

Meta Tag

Author List Nagendra Babu Indurti, Rithika Sayabugari, Sravanthi Indurthi, Vishnu Vardhan Kurrothu

Category Clinical Vignettes

Concept Postsurgical Pyoderma Gangrenosum

Concept Pathergy

Concept Systemic Corticosteroid

Concept Cyclosporine

Concept Surgical Site Infection

Distinguished Non-Finalist

Presenter Organization Baton Rouge General

Presenting Author Nagendra Babu Indurti

Track Adult

Keywords

postsurgical pyoderma gangrenosum

reduction mammoplasty

surgical site infection

wound debridement

negative cultures

pathergy

neutrophilic inflammation

systemic corticosteroids

prednisone

immunosuppression

Postsurgical Pyoderma Gangrenosum

Pathergy

Systemic Corticosteroid

Cyclosporine

Surgical Site Infection