Pyoderma gangrenosum with severe systemic features, after augmentation mammoplasty

Beeckman, Marine [UCL] Peeters, Caroline [UCL] Coyette, Maude [UCL] Marot, Liliane [UCL] Yildiz, Halil [UCL] Lengelé, Benoît [UCL] Baeck, Marie [UCL]

We report a rare life-threatening presentation of postsurgical pyoderma gangrenosum (PG) after augmentation mammoplasty in a 32-year-old woman. Six days after surgery, the patient presented with fever and erythema at surgical wounds. In view of a suspected postsurgical infection, the patient was first treated with antibiotics and removal of breast protheses. In spite of this treatment, in a few days the patient developed a state of shock with multiorgan failure. The antibiotic coverage was broadened several times and multiple extensive surgical debridement with resection of the mammary glands were performed but did not improve the clinical situation. Twelve days after admission, the diagnosis of PG with systemic features was suspected and clinical improvement was observed within 24 h of methylprednisolone administration. PG can mimic the cutaneous and systemic features of necrotizing wound infection of surgical site. Biopsy and culture are critical to differentiating necrotizing neutrophilic dermatosis from necrotizing infection. The diagnosis of this less common form of PG is challenging and this case highlights how the frequent misdiagnosis with infection may result in ineffective antibiotic treatment and how the unnecessary surgical debridement may prolong and exacerbate the condition.