ePlasty: Vol. 11
Necrotizing Fasciitis Versus Pyoderma Gangrenosum: Securing the Correct Diagnosis! A Case Report and Literature Review
Kamal Bisarya, BSc (Hons), MBBS (Lond), MRCS (Eng), MSc, Silvan Azzopardi, MD, BCHD, MRDSRCS (Eng), MRCS (Ed), George Lye, MBBS, and Peter James Drew, MB BCH, FRCS, FRCS (Ed), FRCS (Plast)

Welsh Centre for Burns and Plastic Surgery, Morriston, Swansea


Correspondence: kamalb@doctors.org.uk

Objective: To highlight the key differences in history, examination, and management of pyoderma gangrenosum and necrotizing fasciitis and to outline the importance of distinguishing these 2 conditions. Method: We present a case report of a gentleman with a background of ulcerative colitis having a 1-week history of an erythematous wound and localized abscess to the right leg that failed to respond to antibiotic treatment and later on to surgical debridement of a presumed necrotizing fasciitis. Following referral to our plastic surgery unit, a diagnosis of pyoderma gangrenosum was made and this was confirmed following a response to steroid therapy within 48 hours. A literature review of pyoderma gangrenosum cases misdiagnosed for necrotizing fasciitis was carried out to compare and contrast pitfalls in misdiagnosing these 2 conditions. Results: Literature review of 10 cases confirmed the association of pyoderma gangrenosum with inflammatory bowel disease, hematological disease, and surgical trauma. The presence of necrotic tissue in a pyoderma gangrenosum lesion can be a diagnost .......