Pyoderma gangrenosum secondary to severe burn injury
Serag Saleh1, Bish Soliman1, 1Royal North Shore Hospital
Abstract
Background
Pyoderma gangrenosum is an uncommon cutaneous inflammatory dermatosis classically characterised by the formation of sterile, ulcerating lesions that are rapidly progressive and demonstrate a neutrophilic infiltrate on histology. A hallmark of the disease is pathergy, which is the occurrence of disease at sites of previous trauma and typically extending beyond the area of initial injury. There is a strong correlation of the disease with a cluster of autoimmune-mediated conditions, and the preferred treatment is early systemic corticosteroids and immunosuppressant medications. Although currently without a clearly elucidated aetiology, it is well established within the literature that trauma, often minor, precipitates the lesions, as do attempts at surgical management. However, the role of burns in precipitating the disease is not widely reported.
Method
First, we present a review of the current literature describing pyoderma gangrenosum in the context of significant burn injuries. Second, we present the case of a 60 year old male with a new diagnosis of superficial pyoderma gangrenosum after sustaining 27% total body surface area flame burns.
Results and Conclusion:
Pyoderma gangrenosum is a rare condition that may be precipitated by burn injuries; however, this correlation is not widely recognised and is infrequently reported in the literature. As a diagnosis of exclusion, it presents a diagnostic challenge in the context of severe burns and should be considered in patients with slow healing or deteriorating burns without clear alternate cause. An understanding of its clinical presentation in this setting is essential in guiding early treatment and minimising surgical intervention which may exacerbate its progress.
Biography
Serag is currently a Plastics SRMO at Gosford Hospital.