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Misdiagnosed Periocular Pyoderma Gangrenosum Requiring Ectropion Repair With Development of Second Lesion of Pyoderma Gangrenosum at Graft Site

Caren Campbell, MD1; Jeffrey P. Callen, MD1,2
[+] Author Affiliations
1Division of Dermatology, University of Louisville, Louisville, Kentucky
2Associate Editor, JAMA Dermatology
JAMA Dermatol. 2016;152(4):491-492. doi:10.1001/jamadermatol.2016.0062.
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Extract

This case report describes misdiagnosed periocular pyoderma gangrenosum requiring ectropion repair and the development of second lesion of pyoderma gangrenosum at the graft site.

Pyoderma gangrenosum (PG) is a rare ulcerating inflammatory skin disease diagnosed after exclusion of infection, neoplasia, thrombophilia, and other inflammatory conditions. The incidence is between 3 to 10 patients per million and affects slightly more women than men in the second through fifth decades of life.1 The pathogenesis of PG is multifactorial and involves neutrophilic dysfunction, inflammatory mediators, and a genetic predisposition. Considering the diagnosis of PG for nonhealing ulcers that show a predominance of neutrophils on pathologic analysis is important to prevent unnecessary morbidity.

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Figure 1.
Pyoderma Gangrenosum of Left Eye

Erythematous plaque with crust and rolled violaceous borders on initial presentation.

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Figure 2.
Subsequent Pyoderma Gangrenosum of Graft Site on Right Clavicle

Erythematous ulcerated plaques with violaceous rolled borders at ectropion repair graft site.

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