Pyoderma gangrenosum after totally implanted central venous access device insertion
Pyoderma gangrenosum is an aseptic skin disease. The ulcerative form of pyoderma gangrenosum is characterized by a rapidly progressing painful irregular and undermined bordered necrotic ulcer.
The aetiology of pyoderma gangrenosum remains unclear. In about 70% of cases, it is associated with a systemic disorder, most often inflammatory bowel disease, haematological disease or arthritis.
In 25-50% of cases, a triggering factor such as recent surgery or trauma is identified. Treatment consists of local and systemic approaches.
Systemic steroids are generally used first. If the lesions are refractory, steroids are combined with other immunosuppressive therapy or to antimicrobial agents.Case presentationA 90 years old patient with myelodysplastic syndrome, seeking regular transfusions required totally implanted central venous access device (Port-a-Cath(R)) insertion.
Fever and inflammatory skin reaction at the site of insertion developed on the seventh post-operative day, requiring the devices explantation. A rapid progression of the skin lesions evolved into a circular skin necrosis.
Intravenous steroid treatment stopped the necrosis progression.
Conclusions: Early diagnosis remains the most important step to the successful treatment of pyoderma gangrenosum.
Author: Ihsan Inan, Patrick O Myers, Ralf Braun, Monica E Hagen and Philippe Morel
Credits/Source: World Journal of Surgical Oncology 2008, 6:31
Published on: 2008-03-06
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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