Pyoderma Gangrenosum After Enzymatic Debridement

Excerpt

An 80-year-old man with a history of IgA monoclonal gammopathy presented with a painful ulcerative lesion on his right knee (Fig. 1) that had developed in response to a lanced pustule. Failure of empiric antibiotics led to a punch biopsy, which showed nonspecific acute and chronic inflammation. A diagnosis of pyoderma gangrenosum was made based on negative tissue cultures, characteristic pain, and a classic clinical appearance. Oral cyclosporine resulted in improvement of the lesion. After discharge, he was lost to follow-up, discontinued the use of cyclosporine, and consulted an outside wound care provider, who initiated a regimen containing topical collagenase for enzymatic debridement. The patient was readmitted with worsening of the lesion (Fig. 2) and hemodynamically significant bleeding. He required blood transfusions but responded well to oral prednisone and avoidance of further mechanical and chemical trauma.

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