Background
Only four case reports12 of pyoderma gangrenosum (PG) precipitated by burn injury have been reported in the literature. We present the case of an otherwise well 78-year-old man who sustained a superficial scald burn to the wrist who was referred with concern for infection three days post injury with increasing pain and worsening wound appearance.
Methods
In addition to a review of the literature, a retrospective review was undertaken of the patient’s clinical course including medical records, serial clinical photographs and histopathology slides.
Results
The patient was admitted, started on intravenous antibiotics and proceeded to the operating theatre for a scrub down and assessment of the wound. Intraoperatively, the wound demonstrated violaceous edges and a spongiform-appearing base, findings atypical for an acute superficial burn. A biopsy was taken for histology which later confirmed the diagnosis of PG. The wound was monitored over the subsequent days and continued to progress with further enlargement and increasingly prominent violaceous edges. Systemic corticosteroid treatment was commenced resulting in clinical improvement and re-epithelialisation.
Conclusion
PG is a rare but important differential diagnosis in patients with an atypical burn wound, particularly where pain is a factor and there are no convincing clinical features of infection. Early recognition is essential as surgical debridement or skin grafting may exacerbate disease. Systemic corticosteroid treatment, together with good dressing care, remains the mainstay of treatment.