Brief Report
Pyoderma gangrenosum of the breasts precipitated by breast surgery

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Pyoderma gangrenosum may occur in unusual sites and not be readily recognized. Delays in diagnosis and appropriate treatment may result in extensive ulcerations and scarring. We present two patients with pyoderma gangrenosum involving the breasts after breast operation. Delays in diagnosis resulted in extensive ulcerations and scarring of the breasts.

Section snippets

Case 1

A 58-year-old woman presented with ulcerations involving both breasts (Fig 1) after breast reduction operation. The ulcerations began at the incision sites 3 weeks postoperatively. Despite 4 hospital admissions for intravenous antibiotics and surgical debridement, the ulcerations progressed. There was no history of ulcerations.

The patient had a history of ulcerative colitis, which had been recently quiescent. Biopsy specimens from the edge of the ulcerations showed dermal abscess and

Diagnostic challenge

In both these patients, ulcers developed on the breasts for no apparent reason. The differential diagnosis was wide. In the first patient, aggressive debridement, intravenous antibiotics, and repeated hospitalizations had only resulted in more extensive ulcerations. In the second, ulcerations extended despite wound care and antibiotic treatment. The clues to the diagnosis were the occurrence of pathergy, the characteristic clinical appearance, and, in the first case, a history of a

Discussion

Pyoderma gangrenosum is an infrequent phenomenon that may not be readily recognized. A delay in the diagnosis, however, may lead to numerous hospitalizations, prolonged therapy, and extensive scarring, all of which might be prevented with early recognition. Therefore, a dermatologist's opinion should be sought in cases of nonhealing ulcers, and biopsy must be performed so as not to misdiagnose this entity.12 A response to treatment is usually dramatic and occurs within the first 2 weeks.

Our

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Conflicts of interest: None identified.

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