Pyoderma Gangrenosum on Abdomen of a Man Following Laparoscopic Partial Nephrectomy

June 1, 2006

Two weeks after undergoing a laparoscopic partial nephrectomy for renal adenocarcinoma, a 78-year-old man with myelodysplastic syndrome was hospitalized with nonhealing abdominal wounds. The patient had started a course of oral cephalexin 4 days before admission to treat erythematous areas at 2 of the trocar port sites.

 

Two weeks after undergoing a laparoscopic partial nephrectomy for renal adenocarcinoma, a 78-year-old man with myelodysplastic syndrome was hospitalized with nonhealing abdominal wounds. The patient had started a course of oral cephalexin 4 days before admission to treat erythematous areas at 2 of the trocar port sites.

In the hospital, the antibiotic regimen was modified because of concerns about a resistant organism; blood cultures remained negative. A biopsy of the nonhealing wound was performed because cultures of noninvasive wound swabs showed no evidence of fungal, bacterial, or mycobacterial infection. Sarah Beckman Gratton, MD, and Niraj L. Sehgal, MD, MPH, of San Francisco report that the pathologic results demonstrated a dense neutrophilic dermatosis, consistent with pyoderma gangrenosum.

The cause of pyoderma gangrenosum is unknown. Although commonly associated with inflammatory bowel disease, this ulcerative skin disease has also been reported in patients with myeloproliferative disorders, such as myeloid leukemia.1,2

Pathergy, or ulceration after skin trauma, is frequently noted in patients with pyoderma gangrenosum; in this case, it developed with trocar use. The patient received weekly intradermal corticosteroid injections, and his condition steadily improved.

References:

REFERENCES:


1.

Callen JP. Pyoderma gangrenosum and related disorders.

Med Clin North Am.

1989;73:1247-1261.

2.

Romano J, Safai B. Pyoderma gangrenosum and myeloproliferative disorders. Report of a case and review of the literature.

Arch Intern Med.

1979;139:932-934.