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Perianal pyoderma gangrenosum after excision and fulguration of anal condyloma acuminatum

INTRODUCTION: Pyoderma gangrenosum (PG) is a rare, inflammatory skin pathology frequently associated with systemic inflammatory disease. While rare after surgery, recognition of this disease in the post-surgical setting is important as it can mimic wound infection. PRESENTATION OF CASE: We herein pr...

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Autores principales: Agnew, Jennifer L., Strombom, Paul D., Fong, Carmen F., Kelly, Timothy J., Martz, Joseph E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701749/
https://www.ncbi.nlm.nih.gov/pubmed/26547888
http://dx.doi.org/10.1016/j.ijscr.2015.10.010
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author Agnew, Jennifer L.
Strombom, Paul D.
Fong, Carmen F.
Kelly, Timothy J.
Martz, Joseph E.
author_facet Agnew, Jennifer L.
Strombom, Paul D.
Fong, Carmen F.
Kelly, Timothy J.
Martz, Joseph E.
author_sort Agnew, Jennifer L.
collection PubMed
description INTRODUCTION: Pyoderma gangrenosum (PG) is a rare, inflammatory skin pathology frequently associated with systemic inflammatory disease. While rare after surgery, recognition of this disease in the post-surgical setting is important as it can mimic wound infection. PRESENTATION OF CASE: We herein present a dramatic presentation of perianal PG four days after routine excision and fulguration of anal condyloma acuminatum. The affected area did not improve with broad spectrum antibiotics or surgical debridement. A diagnosis of PG was made from clinical suspicion and pathology findings, and further confirmed with rapid improvement after starting steroids. Diagnosis of this disease in the postoperative period requires high suspicion when the characteristic ulcerative or bullae lesions are seen diffusely and show minimal improvement with antibiotic treatment or debridement. DISCUSSION: Our case highlights the importance of recognizing this disease in the post-operative period, to allow for early initiation of appropriate treatment and prevent unnecessary surgical debridement of a highly sensitive area. There have been 32 case reports of PG in the colorectal literature, mostly following stoma creation. There is one case report of idiopathic perianal pyoderma gangrenosum with no known prior trauma. To our knowledge there are no previously reported cases of perianal PG after routine elective anorectal surgery. CONCLUSION: This is the first reported case of perianal pyoderma gangrenosum in the post-surgical setting. Increased awareness of pyoderma gangrenosum in the surgical literature will aid in prompt diagnosis and proper medical management of this uncommon postoperative morbidity.
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spelling pubmed-47017492016-02-03 Perianal pyoderma gangrenosum after excision and fulguration of anal condyloma acuminatum Agnew, Jennifer L. Strombom, Paul D. Fong, Carmen F. Kelly, Timothy J. Martz, Joseph E. Int J Surg Case Rep Case Report INTRODUCTION: Pyoderma gangrenosum (PG) is a rare, inflammatory skin pathology frequently associated with systemic inflammatory disease. While rare after surgery, recognition of this disease in the post-surgical setting is important as it can mimic wound infection. PRESENTATION OF CASE: We herein present a dramatic presentation of perianal PG four days after routine excision and fulguration of anal condyloma acuminatum. The affected area did not improve with broad spectrum antibiotics or surgical debridement. A diagnosis of PG was made from clinical suspicion and pathology findings, and further confirmed with rapid improvement after starting steroids. Diagnosis of this disease in the postoperative period requires high suspicion when the characteristic ulcerative or bullae lesions are seen diffusely and show minimal improvement with antibiotic treatment or debridement. DISCUSSION: Our case highlights the importance of recognizing this disease in the post-operative period, to allow for early initiation of appropriate treatment and prevent unnecessary surgical debridement of a highly sensitive area. There have been 32 case reports of PG in the colorectal literature, mostly following stoma creation. There is one case report of idiopathic perianal pyoderma gangrenosum with no known prior trauma. To our knowledge there are no previously reported cases of perianal PG after routine elective anorectal surgery. CONCLUSION: This is the first reported case of perianal pyoderma gangrenosum in the post-surgical setting. Increased awareness of pyoderma gangrenosum in the surgical literature will aid in prompt diagnosis and proper medical management of this uncommon postoperative morbidity. Elsevier 2015-10-23 /pmc/articles/PMC4701749/ /pubmed/26547888 http://dx.doi.org/10.1016/j.ijscr.2015.10.010 Text en © 2015 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Agnew, Jennifer L.
Strombom, Paul D.
Fong, Carmen F.
Kelly, Timothy J.
Martz, Joseph E.
Perianal pyoderma gangrenosum after excision and fulguration of anal condyloma acuminatum
title Perianal pyoderma gangrenosum after excision and fulguration of anal condyloma acuminatum
title_full Perianal pyoderma gangrenosum after excision and fulguration of anal condyloma acuminatum
title_fullStr Perianal pyoderma gangrenosum after excision and fulguration of anal condyloma acuminatum
title_full_unstemmed Perianal pyoderma gangrenosum after excision and fulguration of anal condyloma acuminatum
title_short Perianal pyoderma gangrenosum after excision and fulguration of anal condyloma acuminatum
title_sort perianal pyoderma gangrenosum after excision and fulguration of anal condyloma acuminatum
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701749/
https://www.ncbi.nlm.nih.gov/pubmed/26547888
http://dx.doi.org/10.1016/j.ijscr.2015.10.010
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