Wirtzfeld N, Paquet P, Lemineur T, Lutgen M, Bouaziz J-D, Denoel C
Faculté de Médecine, Université de Liège, Belgique.
Service de Dermatologie, CHU de Liège, Site Sart Tilman, Liège, Belgique.
Rev Med Liege. 2017 May;72(5):227-232.
Pyoderma gangrenosum (PG) is a rare pustular and ulcerative inflammatory disease belonging to the group of neutrophilic dermatoses. It is frequently associated with systemic immune diseases. In this context the PG can be exceptionally triggered by tissue trauma such as surgery (pathergy). We report the case of a patient with stabilized rheumatoid arthritis who developed aggressive and disseminated PG at all surgical wounds following an abdominal dermolipectomy associated with breast pexy. Systemic corticosteroid methylprednisolone allowed a rapid control of skin ulcerations. In the aftermath of an intervention, PG is often confused with a bacterial skin-necrotizing panniculitis. The recognition of the inflammatory nature of cutaneous symptoms is crucial to quickly start an immunosuppressive treatment and limit scarring sequelae. Our case also illustrates the need to consider any history of dysimmune inflammatory or oncohematological disease as a risk factor before surgery, even if the latter are stabilized.
坏疽性脓皮病（PG）是一种罕见的脓疱性和溃疡性炎症性疾病，属于嗜中性皮肤病组。它常与全身性免疫疾病相关。在这种情况下，PG可由手术等组织创伤异常引发（同形反应）。我们报告了一例类风湿关节炎病情稳定的患者，在接受腹部皮肤切除术并伴有乳房固定术后，所有手术伤口均出现侵袭性和播散性PG。全身性皮质类固醇甲泼尼龙使皮肤溃疡迅速得到控制。在干预后，PG常与细菌性皮肤坏死性脂膜炎相混淆。认识到皮肤症状的炎症性质对于迅速开始免疫抑制治疗并限制瘢痕后遗症至关重要。我们的病例还表明，即使免疫性炎症或肿瘤血液学疾病病情稳定，在手术前也需要将任何此类病史视为危险因素。
