These excruciatingly painful left leg lesions began after a minor scratch five month earlier. New lesions had continued to form in response to debridements at another wound center. She had a new and rapidly enlarging anterior shin lesion on the other leg that formed after a minor scratch from her dog. (Hint, pathergy!)
Her first tearful question was, “Are you going to debride this?”
Arterial screening with skin perfusion pressure showed normal arterial supply. Biopsy did not show pyoderma gangrenosum however, the appearance of the lesions, the presence of pathergy and the clinical history provide a textbook picture of PG. Additionally, she has “bird fancier’s lung,” an underlying inflammatory condition!
Additional lesions formed after debridement
Minor Dog Scratch
After only 4 weeks she’s dramatically improved thanks to a brief course of high dose prednisone (60 mg) which completely stopped her pain.
In consultation with her pulmonology and dermatology, she’s transitioning to Cyclosporine which hopefully will manage both her pulmonary and her cutaneous disease.
C’mon folks, this is a textbook case of Pyoderma Gangrenosum.
Don’t debride these.
Initial visit – nearly circumferential lesion
After 9 days of Prednisone and transitioning to Cyclosporine
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
Ty! Why didn’t the punch biopsy show the PG?