Pluta Natalia A, Kemp Tamara L, Rivard Shayna C
From the Uniformed Services University of the Health Sciences, Bethesda, MD.
Department of Plastic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA.
Plast Reconstr Surg Glob Open. 2025 Jan 10;13(1):e6448. doi: 10.1097/GOX.0000000000006448. eCollection 2025 Jan.
Pyoderma gangrenosum (PG) is a rare, often idiopathic, noninfectious inflammatory neutrophilic dermatitis that causes painful ulcerative cutaneous papillomatous lesions. PG often mimics surgical infection, wound dehiscence, and postoperative cellulitis, leading to high rates of misdiagnosis and mistreatment. Here, a healthy 17-year-old adolescent girl with congenital breast asymmetry, macromastia, and a history of only mild intermittent autoimmune conditions developed an open wound along her inferior left breast incision 2 weeks after reduction mammoplasty. With continued enlargement and development of new ulcerative lesions despite appropriate local wound care, clinical suspicion for PG was raised. Standard treatment with oral prednisolone and topical tacrolimus led to incomplete resolution, and subsequent regression on attempts to taper the corticosteroid. Transition to oral cyclosporine with continued daily topical tacrolimus ultimately led to complete healing. This case underscores the need for a high clinical suspicion for PG in nonhealing ulcerative lesions after breast surgery, in addition to the importance of timely initiation of immunomodulatory agents and modification of the regimen if incomplete resolution is encountered.
坏疽性脓皮病（PG）是一种罕见的、通常病因不明的非感染性炎症性嗜中性粒细胞性皮炎，可导致疼痛性溃疡性皮肤乳头状病变。PG常酷似手术感染、伤口裂开和术后蜂窝织炎，导致误诊和误治率很高。在此，一名健康的17岁青春期女孩，有先天性乳房不对称、巨乳症，且仅有轻度间歇性自身免疫性疾病史，在乳房缩小成形术后2周，其左乳房下切口处出现一个开放性伤口。尽管进行了适当的局部伤口护理，但伤口持续扩大并出现新的溃疡性病变，于是临床怀疑为PG。口服泼尼松龙和外用他克莫司的标准治疗未能完全缓解，随后在试图逐渐减少皮质类固醇药物用量时病情出现反复。改用口服环孢素并继续每日外用他克莫司最终实现了完全愈合。该病例强调，对于乳房手术后不愈合的溃疡性病变，除了及时启动免疫调节药物治疗以及在疗效不完全时调整治疗方案外，还需要高度怀疑PG。
