Pyoderma Gangrenosum after Hand Surgery: A Case Report
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Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis that can be triggered after minor trauma or surgery and mimics a fulminating infection. Early diagnosis is important for PG, which prevents unnecessary surgeries.

It is commonly associated with a systemic disease, such as inflammatory bowel disease, metabolic syndrome, rheumatologic or hematological disorders, and malignancies.

A report of PG, originally misdiagnosed as an infection after a carpal tunnel release, is presented. An 81-year-old female was presented with the characteristic symptoms of carpal tunnel syndrome (CTS): numbness and nightly paresthesia in the thumb, index finger, and middle finger of the right hand as well as difficulties with fine motor activities like buttoning shirts. A hand surgeon performed the CTR of the right hand without complication. After reinfections and still deteriorating condition, a dermatological consultation followed, and PG was diagnosed.

The typical clinical appearance is hemorrhagic nodules, which rapidly progress into extremely painful, irregular, red to violaceous ulceration with undermined border and purulent necrotic bases. The treatment of PG is nonsurgical. Unnecessary surgical procedures may incite a pathergic response, worsening the disease dramatically and potentially resulting in limb amputation.

This case emphasizes the importance of early recognition of PG to provide a timely diagnosis and avoid unnecessary surgeries, which can result in devastating consequences.