Untreatable Surgical Site Infection: Consider Pyoderma Gangrenosum

Pyoderma gangrenosum (PG) is an inflammatory disease characterized by sterile infiltration of the skin by neutrophils. We describe a case of a 63-year-old woman who developed PG following an abdominal wall reconstruction. Her initial presentation was thought to be consistent with a surgical site infection. Antibiotic therapy was initiated, and the patient was taken for multiple irrigation/lavage of her abdomen and debridement of necrotic tissue. Wound cultures remained negative, and maximal antibiotic coverage did not halt tissue breakdown. A trial of steroids was initiated, and the patient’s condition subsequently improved. Tissue biopsy results were compatible with the diagnosis of PG.