Iosifescu A G, Boiangiu C I, Comănescu C M, Iliescu V A
Cardiac Surgery Unit no. 2, "Prof. Dr. C.C. Iliescu" Emergency Institute for Cardiovascular Disease, Bucharest, Romania.
Chirurgia (Bucur). 2012 Jan-Feb;107(1):119-21.
Pyoderma gangrenosum is a skin ulcerative necrosis, due to dermal neutrophilic infiltration, through a non-infectious exacerbation of cell -mediated immunity. Being characterized by pathergy, the disease may be triggered by surgery; in this case, it is easily mistaken for a postoperative infection. We report a case of pyoderma gangrenosum after coronary artery bypass surgery. The patient developed, from the 7th postoperative day, around the incisions, dermo-epidermic lesions specific for the disease, high fever with chills and a severe biological inflammatory syndrome. Treatment for wound sepsis was ineffective. After pyoderma gangrenosum was recognized, corticosteroids (Prednisone 80 mg/d) led, in two days time, to a spectacular improvement, and in 7 weeks, to complete epithelization of the lesions. If after debridement of a supposedly infected wound (with pustules, bullae or ulcerations), there is no improvement, but a centrifugal extension of the lesions, with a "sepsis-like" syndrome and persistent negative cultures, one should think at pyoderma gangrenosum; in that case, not the antibiotics, but corticosteroids (or other immunosuppressants) are the treatment.
坏疽性脓皮病是一种皮肤溃疡性坏死，由于真皮中性粒细胞浸润，通过细胞介导免疫的非感染性加重所致。该疾病以同形反应为特征，可由手术引发；在这种情况下，它很容易被误诊为术后感染。我们报告一例冠状动脉搭桥手术后发生坏疽性脓皮病的病例。患者术后第7天起，在切口周围出现该病特有的真皮表皮病变，伴有高热、寒战和严重的生物学炎症综合征。伤口脓毒症的治疗无效。坏疽性脓皮病被确诊后，给予皮质类固醇（泼尼松80mg/d）治疗，两天内病情显著改善，7周后病变完全上皮化。如果对一个疑似感染的伤口（有脓疱、大疱或溃疡）进行清创后没有改善，反而病变呈离心性扩展，伴有“脓毒症样”综合征且培养持续阴性，应考虑坏疽性脓皮病；在这种情况下，治疗应使用皮质类固醇（或其他免疫抑制剂）而非抗生素。
