Pyoderma gangrenosum

Complicatie na operatieve behandeling voor carpaletunnelsyndroom
Casuïstiek
10-06-2019
Daan Geerards, Thijs de Wit en Guido H.C.G. Dolmans

Pyoderma gangrenosum: a complication following surgery for carpal tunnel syndrome

Background

Pyoderma gangrenosum is a rare condition with an unpredictable disease course. The condition is accompanied by tissue decay and recognition often comes late. Pyoderma gangrenosum has clinical features similar to an infection, but does not react to antibiotics. The condition can develop following a surgical procedure or can be worsened by one. To date, only one other case of pyoderma gangrenosum following surgery for carpal tunnel syndrome has been described in the literature.

Case description

A 60-year-old man developed painful ulcers shortly after surgery for carpal tunnel syndrome, a clinical picture representing a serious infection. Antibiotics and surgical debridement did not lead to improvement. Cultures from the wound did not contain micro-organisms. Following histological investigation a diagnosis of pyoderma gangrenosum was made. Administration of a high dosage of prednisone led to a swift improvement and the wound healed.

Conclusion

Timely recognition of pyoderma gangrenosum is essential to prevent unnecessary surgical treatment and worsening of the condition. Systemic glucocorticoids are the treatment of first choice for pyoderma gangrenosum.

Conflict of interest and financial support: none declared.