Pyoderma gangrenosum after trauma to the dorsum of the hand

• Published in: Revista Brasileira de cirurgia plástica Vol. 35; no. 1; pp. 121 - 128
• Main Authors: Rezende, Altino Vieira de, Macedo, Jefferson Lessa, Rosa, Simone Correa, Yamamoto, Heloiza Gutierrez, Fioravante, Thaiane da Guia Rosa, Garcia, Jorge Emílio França, Cordini, Guilherme Debiazi, Gondim, Flavio Freitas
• Format: Journal Article
• Language: English
• Published: Sociedade Brasileira de Cirurgia Plástica 2020
• Subjects: autoimmune diseases; multiple trauma; pyoderma gangrenosum; upper extremity; wounds and injuries
• ISSN: 2177-1235; 1983-5175; 2177-1235
• DOI: 10.5935/2177-1235.2020RBCP0020

Introduction: Cullen’s postoperative gangrene, also called pyoderma gangrenosum (PG) or sterile neutrophilic abscess, was first described in the medical literature by Cullen in 1924. Later Brusting et al., in 1930, described PG in more detail. Objective: To report a rare case of pyoderma gangrenosum (PG) in an extraneous limb that was triggered by blunt trauma to the dorsum of the hand. Discussion: A histopathological exam is not sufficient to diagnose PG, Therefore, a PG diagnosis is based on clinical evidence. The clinical presentation is variable and includes rare bullous, pustular and vegetative forms. Other rare forms of PG occur at sites of pathergy (20-30%), periostomal skin, the dorsum of the hand, the head and neck. PG can also be multisystemic and paraneoplastic. Conclusion: The appearance of sudden-onset PG is rare in the dorsum of the hand. It is important to classify PG’s clinical forms, and to establish associations between PG and underlying pathologies. It is also very important to avoid surgery during early PG. The many drugs used to treat PG, and the multiple patient responses, demonstrate the difficulty of standardizing treatment. Physicians may have to use an empirical approach to select the appropriate drug for each patient.