Suzuki Kei, Sieczka Elizabeth, Tranbaugh Robert, Hoffman Darryl
Beth Israel Medical Center, Department of Surgery, United States.
Beth Israel Medical Center, Division of Plastic Surgery, United States.
Int J Surg Case Rep. 2015;6C:163-5. doi: 10.1016/j.ijscr.2014.06.010. Epub 2014 Dec 11.
Pyoderma gangrenosum (PG) is a rare, ulcerative inflammatory skin pathology frequently associated with systemic inflammatory disease. While rare after surgery, recognition of this disease in the post-surgical setting is important as it can mimic wound infection. There have been ten case reports to date of PG occurring immediately after cardiac surgery, with all of them presenting within the first week post-operatively.
We herein present a delayed and dramatic presentation of PG nine days after mitral valve replacement and repair of patent foramen ovale, two days after being discharged with a seemingly normal healing wound. Diagnosis of this disease in the postoperative period requires high suspicion when the characteristic ulcerative lesions are seen diffusely in all surgical wounds and show minimal improvement with antibiotic treatment or debridement.
DISCUSSION/CONCLUSION: Our case highlights the importance of recognizing this disease in the postoperative period, even in a delayed presentation and initially limited to one of the surgical sites. This case calls for an awareness of this disease entity amongst cardiac surgeons as well as intensivists.
坏疽性脓皮病（PG）是一种罕见的溃疡性炎症性皮肤疾病，常与全身性炎症性疾病相关。虽然术后罕见，但在术后环境中识别这种疾病很重要，因为它可能会被误诊为伤口感染。迄今为止，有10例关于心脏手术后立即发生PG的病例报告，所有病例均在术后第一周内出现。
我们在此报告一例二尖瓣置换和卵圆孔未闭修复术后九天出现的延迟且严重的PG病例，患者在伤口看似正常愈合并出院两天后发病。当在所有手术伤口中广泛出现特征性溃疡性病变且抗生素治疗或清创后改善甚微时，术后诊断这种疾病需要高度怀疑。
讨论/结论：我们的病例强调了在术后阶段识别这种疾病的重要性，即使是延迟出现且最初仅局限于一个手术部位。该病例呼吁心脏外科医生以及重症监护医生对这种疾病有所认识。
