R Stephen J Burnett1, Rajesh Nair2, Douglas M Sawyer3, Ariella Z Zbar4, James W Mathers4. 1. Department of Orthopaedic Surgery, University of British Columbia, Island Health, Royal Jubilee Hospital, Rebalance MD, Suite 104, 3551 Blanshard Street, Victoria, BC V8Z-0B9, Canada. 2. Rebalance MD, Suite 104, 3551 Blanshard Street, Victoria, BC V8Z-0B9. 3. Department of Anatomic Pathology, University of British Columbia, Island Health, Royal Jubilee Hospital, 5th floor, 1952 Bay Street, Victoria, BC V8R-1J8, Canada. 4. Island Medical Program, Medical Science Building, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W-2Y2, Canada.
Abstract
CASE: We describe the clinical and histopathological findings associated with a case of pyoderma gangrenosum (PG) after revision total hip arthroplasty. The patient developed an expanding purple-red, necrotic, ulcerative lesion at the surgical site, which was initially suspected to be either a surgical-site infection or warfarin-induced skin necrosis. After treatment with empiric intravenous antibiotics, surgical debridement, and vacuum-assisted closure of the wound, the patient had a painless hip with a remodeled scar and was asymptomatic at the seven-year follow-up. CONCLUSION: Confirmation of the diagnosis of surgical-site PG requires clinical-pathological correlation and familiarity with the PG skin lesion. Treatment of PG differs from treatment of infection; therefore, misdiagnosis and surgical treatment may exacerbate the clinical findings in PG.
CASE: We describe the clinical and histopathological findings associated with a case of pyoderma gangrenosum (PG) after revision total hip arthroplasty. The patient developed an expanding purple-red, necrotic, ulcerative lesion at the surgical site, which was initially suspected to be either a surgical-site infection or warfarin-induced skin necrosis. After treatment with empiric intravenous antibiotics, surgical debridement, and vacuum-assisted closure of the wound, the patient had a painless hip with a remodeled scar and was asymptomatic at the seven-year follow-up. CONCLUSION: Confirmation of the diagnosis of surgical-site PG requires clinical-pathological correlation and familiarity with the PG skin lesion. Treatment of PG differs from treatment of infection; therefore, misdiagnosis and surgical treatment may exacerbate the clinical findings in PG.
Authors: Michał Wasiak; Michał Ciszek; Ireneusz Babiak; Piotr Wasilewski; Paweł Łęgosz; Bartosz Kieroński; Paweł Małdyk Journal: Reumatologia Date: 2022-09-08