Challenges in diagnosing pyoderma gangrenosum in a severely burned patient: A case report and literature review

Abstract

Pyoderma gangrenosum (PG) is a rare skin disorder characterised by infection and skin necrosis. The diagnosis is not easily made, and is usually a diagnosis of exclusion. We share our experience with a 31-year-old female patient diagnosed with PG of the lower legs based on clinical characteristics and by exclusion of other causes. A literature review was done for PG and burns. A PubMed search for PG found 3 619 results, and when searching for PG and burns, only 25 articles were found. Of the 25 articles, 9 were relevant, of which only 5 full-text articles could be retrieved. The 5 selected articles reported a total of 7 cases of PG in burns. Five out of the 7 cases were females, and the other 2 male patients. Three areas were affected: shoulders (3/7), breasts (2/7) and legs (2/7). The age of the patients varied from 24 to 74 years, and the average age was 42. All patients received successful treatment with a course of steroids, but with variable regimens. The diagnosis of PG can be challenging as a result of many factors, such as inexperience in diagnosing PG, variable clinical appearances of PG, impression of simple wound infection rather than PG, wide differential of PG and, lastly, unfamiliarity of dermatologists in diagnosing PG in burn patients.