PR06 NECROTISING FASCIITIS OR PYODERMA GANGRENOSUM – AN INTERESTING CASE

Purpose  Using a case study, to raise awareness of the diagnosis of Pyoderma gangrenosum in the clinically septic patient with a rapidly deteriorating wound. To support the use of VAC dressings in patients with pyoderma gangrenosum. Methodology  Case Study – Mr DL is a 30 yo man who presented 7 days after an angle grinder injury to his left thigh. He was clinically septic with a rapidly expanding area of necrosis over the injury site. His other presenting problem was a platelet count of 14 × 10 −9 /L, which was later diagnosed as myelodysplasia. Cultures grew coagulase negative staphylococcus, and initial biopsies showed extensive necrotic tissue and suppurative inflammation. Despite multiple wound debridements and appropriate intravenous antibiotics, the patient was still clinically septic with a deteriorating wound. It was only on the second biopsy that pyoderma gangrenosum was diagnosed. He was then treated with steroids and a vacuum assisted dressing. Results  Mr DL responded well to treatment. The VAC dressing was very successful in promoting healthy granulation tissue. This granulation tissue was later skin grafted with good success. Conclusion  Pyoderma gangrenosum is an important differential diagnosis in wounds that do not seem to improve after debridement, even if the patient appears clinically septic. It is often not easy to diagnose even on histopathological grounds. The Vac dressing is a useful adjunct in the treatment of pyoderma gangrenosum.