Brief ReportPyoderma gangrenosum of the breasts precipitated by breast surgery
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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Cited by (42)
Postoperative and Peristomal Pyoderma Gangrenosum: Subtypes of Pyoderma Gangrenosum
2024, Dermatologic ClinicsPyoderma gangrenosum following reduction mammoplasty: Systematic review of the literature and case report
2024, Journal of Plastic, Reconstructive and Aesthetic SurgeryPyoderma gangrenosum after breast surgery: A systematic review
2018, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :Three papers presented cases of pyoderma gangrenosum at 580 days, 3 years and 7 years after breast surgery; therefore, these papers were not included in the analysis. A total of 68 articles describing 87 cases of PSPG following aesthetic and reconstructive breast surgery were ultimately analysed.3,8,10,12–87 Tables 2 and 3 show the initial screening of the literature, and Tables S4 and S5 show a detailed summary of each study.3,8,10,12–87
Postoperative Pyoderma Gangrenosum: A Clinical Review of Published Cases
2016, Mayo Clinic ProceedingsCitation Excerpt :This investigation was compliant with the US Health Insurance Portability and Accountability Act. Case reports of 156 unique patients were reviewed, and 140 cases were selected (Supplemental Table 1, available online at http://www.mayoclinicproceedings.org).3-5,13-130 Publications of 18 patients had no English translation or did not meet the inclusion timeline (Supplemental Table 2, available online at http://www.mayoclinicproceedings.org).9,131-146
Pyoderma gangrenosum
2012, PielGet It off Your Chest: A Narrative Review of Breast Ulcers
2022, Advances in Skin and Wound Care
Funding sources: None.
Conflicts of interest: None identified.
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