Geerards Daan, de Wit Thijs, Dolmans Guido H C G
Amphia Ziekenhuis, afd. Plastische Chirurgie, Breda.
Contact: G.H.C.G. Dolmans (
Ned Tijdschr Geneeskd. 2019 May 24;163:D3393.
Pyoderma gangrenosum is a rare condition with an unpredictable disease course. The condition is accompanied by tissue decay and recognition often comes late. Pyoderma gangrenosum has clinical features similar to an infection, but does not react to antibiotics. The condition can develop following a surgical procedure or can be worsened by one. To date, only one other case of pyoderma gangrenosum following surgery for carpal tunnel syndrome has been described in the literature.
A 60-year-old man developed painful ulcers shortly after surgery for carpal tunnel syndrome, a clinical picture representing a serious infection. Antibiotics and surgical debridement did not lead to improvement. Cultures from the wound did not contain micro-organisms. Following histological investigation a diagnosis of pyoderma gangrenosum was made. Administration of a high dosage of prednisone led to a swift improvement and the wound healed.
Timely recognition of pyoderma gangrenosum is essential to prevent unnecessary surgical treatment and worsening of the condition. Systemic glucocorticoids are the treatment of first choice for pyoderma gangrenosum.
坏疽性脓皮病是一种罕见疾病，病程难以预测。该病症伴有组织坏死，且往往较晚才被识别。坏疽性脓皮病具有类似感染的临床特征，但对抗生素无反应。这种情况可在外科手术后发生，也可能因手术而恶化。迄今为止，文献中仅描述了另一例腕管综合征手术后发生坏疽性脓皮病的病例。
一名60岁男性在腕管综合征手术后不久出现疼痛性溃疡，临床表现为严重感染。抗生素和手术清创均未改善病情。伤口培养未发现微生物。经组织学检查后诊断为坏疽性脓皮病。给予高剂量泼尼松后病情迅速改善，伤口愈合。
及时识别坏疽性脓皮病对于防止不必要的手术治疗和病情恶化至关重要。全身性糖皮质激素是坏疽性脓皮病的首选治疗方法。
