Shono Yoko, Sekioka Akinori, Ota Shuichi, Ito Tetsuo, Adachi Yukito
Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, JPN.
Gastroenterological Surgery, Osaka Saiseikai-Noe hospital, Osaka, JPN.
Cureus. 2023 Mar 6;15(3):e35807. doi: 10.7759/cureus.35807. eCollection 2023 Mar.
Pyoderma gangrenosum (PG) is a nonbacterial ulcerating skin condition. It is typically associated with other systemic disorders. However, approximately 20%-30% of cases are idiopathic. Post-operative PG (PPG) is a rare type of PG with a rapidly expanding cutaneous ulcer at a surgical site and is often misdiagnosed as a wound infection. The difficulty in diagnosis can lead to unnecessary surgical interventions and delay in the treatment of PG. Herein, we present the case of a 68-year-old patient with severe PPG with no underlying diseases. He underwent an emergency laparotomy (Hartmann's procedure) for perforated diverticulitis. After the operation, systemic inflammatory response syndrome (SIRS) developed and the skin around the incisional wound, stoma, injection venous lines, and electrocardiogram monitoring pads gradually became erythematous. Skin biopsy and the absence of a source of infection confirmed the diagnosis of PG. Drug therapy for PG with steroids, and tumor necrosis factor-α inhibitors improved SIRS and the patient recovered.
坏疽性脓皮病（PG）是一种非细菌性溃疡性皮肤病。它通常与其他全身性疾病相关。然而，约20%-30%的病例为特发性。术后坏疽性脓皮病（PPG）是PG的一种罕见类型，在手术部位出现迅速扩大的皮肤溃疡，常被误诊为伤口感染。诊断困难可能导致不必要的手术干预，并延误PG的治疗。在此，我们报告一例68岁无基础疾病的严重PPG患者。他因穿孔性憩室炎接受了急诊剖腹手术（哈特曼手术）。术后，出现全身炎症反应综合征（SIRS），手术切口周围皮肤、造口、静脉注射部位及心电图监测电极片周围皮肤逐渐出现红斑。皮肤活检及未发现感染源确诊为PG。使用类固醇及肿瘤坏死因子-α抑制剂治疗PG改善了SIRS，患者康复。
