Abstract
On the 3rd day following surgery to repair an incisional hernia, a 67-year-old male patient with Werlhof’s disease (idiopathic thrombocytopenic purpura) was diagnosed with a histologically confirmed pyoderma gangraenosum (PG), a rare complication of wound healing. Dexamethasone pulse therapy resulted in rapid remission of the skin lesions. Further improvement was slowed when the patient suffered multiple organ failure in the intensive care unit, delaying his transfer to rehabilitation for 8 weeks. Postoperative PG is always a differential diagnostic possibility in patients with sterile, progressive, painful, ulcerative skin lesions at or near the surgical wound. Unlike most wound healing complications, which are treated by debridement or antibiotics, the treatment of choice for PG is high-dose steroid therapy.
References
Powell FC, Schroeter AL, Su WP, Perry HO (1985) Pyoderma gangrenosum: a review of 86 patients. Q J Med 55:173–186
Brocq L (1916) A new contribution to the study of geometric phagendism. Ann Dermatol Syphiligr (Paris) 9:1–39
Farhi D (2008) The clinical and histopathological description of geometric phagendism (Pyoderma gangrenosum) by Louis Brocq one century ago. Arch Dermatol 144(6):755
Powell FC, Su WP, Perry HO (1996) Pyoderma gangrenosum: classification and management. J Am Acad Dermatol 34:395–409
Van den Driesch P (1997) Pyoderma gangrenosum: a report of 44 cases with follow-up. Br J Dermatol 137:1000–1005
Wollina U (2002) Clinical management of pyoderma gangrenosum. Am J Clin Dermatol 3:149–158
Török L, Kirschner A, Gurzó M, Krenács L (2000) Bullous pyoderma gangrenosum as a manifestation of leukemia cutis. Eur J Dermatol 10:463–465
Dietz UA, Hamelmann W, Winkler MS, Debus ES, Malafaia O, Czeczko NG, Thiede A, Kuhfuß I (2007) An alternative classification of incisional hernias enlisting morphology, body type and risk factors in the assessment of prognosis and tailoring of surgical technique. J Plast Reconstr Aesthet Surg 60(4):383–388
Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, Dietz UA, Eker HH, Nakadi IEl, Hauters P, Hidalgo Pascual M, Hoeferlin A, Klinge U, Montgomery A, Simmermacher RKJ, Simons MP, Smietanski M, Sommerling C, Tollens T, Vierendeels T, Kingsnorth A (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414
Parcival GH (1957) Pyoderma ganrenosum: the histology of the primary lesion. Br J Dermatol 69:130
Sheldon DG, Sawchuk LL, Kozarek RA, Thirlby RC (2000) Twenty cases of peristomal pyoderma gangrenosum: diagnostic implications and management. Arch Surg 135(5):564–568
Veyssier P, Driguez E (1988) Pyoderma gangrenosum associé á une gammapathie monoclonale á IgA er a‘un purpura thrombopénique idiopathique. Rev Méd Interne 9:559–560
King KW, Murray A (2000) Pyoderma gangrensum in a patient with essential thrombocythemia. J Cutan Med Surg 4(2):107–109
Shepard P, Liddell K (1982) Pyoderma gangrenosum associated with primary thrombocythaemia. Br Med J 285:837–838
Brunsting LA (1953) Foreword. J Invest Dermatol 158–161
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Strauß, A., Storim, J., Germer, CT. et al. Pyoderma gangraenosum as rare complication of incisional hernia repair in a patient with Werlhof’s disease. Hernia 15, 709–712 (2011). https://doi.org/10.1007/s10029-010-0712-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-010-0712-x