Correspondence

Pyoderma gangrenosum: unusual complication following mammoplasty reduction A 27‐year‐old woman, with unremarkable previous medical history, underwent a bilateral mammoplasty reduction. Four days afterwards, the surgical wound developed ulcers with pustulous, undermined borders. The patient's general status worsened and high fever (40 °C) developed. Local pain was absent. Initial diagnosis was wound infection, even though bacteriologic cultures were negative, and therapy consisted of oral antibiotics together with surgical debridement. Ten days after the mammoplasty, the ulcers had increased dramatically in size affecting most of the lower half of the breasts. The areolas were spared, and the lesions were strikingly symmetrical ( Fig. 1). The ulcers had a necrotic, hemorrhagic base with fibrin deposition, and pustulous borders. Perilesional edema and inflammation were noted. The patient did not reveal clinical manifestations of inflammatory bowel disease or other illnesses in addition to the skin lesions. At this time, the patient was sent to our department and a diagnosis of pyoderma gangrenosum (PG) was considered. The advancing edge of one ulcer was biopsied and, although histopathologic examination was unspecific, it was consistent with PG. Routine laboratory tests revealed a moderate leukocytosis (14,000/μL, 65% neutrophils), and an acute phase reaction with thrombocytosis (727,000/μL), elevated erythrocyte sedimentation rate (ESR) (84 mm/h), and increased levels of α‐1 and α‐2 globulins. Bacteriologic cultures were negative. Rheumatoid factor and antinuclear antibodies were also negative. Therapy was started with the local application of gauze impregnated with gentamicine ointment, and oral cyclosporine (5 mg/kg/day) and methylprednisolone (0.5 mg/kg/day). Twenty four hours after the onset of therapy, the fever had disappeared. In the first month, the perilesional edema and pustulation resolved, central areas of re‐epithelization were noted, and previously abnormal laboratory tests returned to normal limits. At the end of the second month, the ulcers had completely healed, with residual scarring ( Fig. 2). 1PG ulceration involving most of the lower half of both breasts. Note the sparing of areolas2Residual scarring after resolution of the ulcers