Pyoderma gangrenosum after totally implanted central venous access device insertion
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Case report
Pyoderma gangrenosum after totally implanted central venous access device insertion Ihsan Inan*1, Patrick O Myers1, Rolf Braun2, Monica E Hagen1 and Philippe Morel1 Address: 1Visceral Surgery Unit, Department of Surgery, Geneva University Hospital, Rue Micheli-du-Crest 24, CH-1211 Geneva, Switzerland and 2Dermatology Department, Geneva University Hospital, Rue Micheli-du-Crest 24, CH-1211 Geneva, Switzerland Email: Ihsan Inan* - [email protected]; Patrick O Myers - [email protected]; Rolf Braun - [email protected]; Monica E Hagen - [email protected]; Philippe Morel - [email protected] * Corresponding author
Published: 6 March 2008 World Journal of Surgical Oncology 2008, 6:31
doi:10.1186/1477-7819-6-31
Received: 9 February 2008 Accepted: 6 March 2008
This article is available from: http://www.wjso.com/content/6/1/31 © 2008 Inan et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Pyoderma gangrenosum is an aseptic skin disease. The ulcerative form of pyoderma gangrenosum is characterized by a rapidly progressing painful irregular and undermined bordered necrotic ulcer. The aetiology of pyoderma gangrenosum remains unclear. In about 70% of cases, it is associated with a systemic disorder, most often inflammatory bowel disease, haematological disease or arthritis. In 25–50% of cases, a triggering factor such as recent surgery or trauma is identified. Treatment consists of local and systemic approaches. Systemic steroids are generally used first. If the lesions are refractory, steroids are combined with other immunosuppressive therapy or to antimicrobial agents. Case presentation: A 90 years old patient with myelodysplastic syndrome, seeking regular transfusions required totally implanted central venous access device (Port-a-Cath®) insertion. Fever and inflammatory skin reaction at the site of insertion developed on the seventh postoperative day, requiring the device's explanation. A rapid progression of the skin lesions evolved into a circular skin necrosis. Intravenous steroid treatment stopped the necrosis' progression. Conclusion: Early diagnosis remains the most important step to the successful treatment of pyoderma gangrenosum.
Background Patients undergoing totally implanted central venous access device (TICVAD) insertion are frequently at risk of infection, firstly by implanting foreign material, which can be colonized and difficult to treat, secondly because the underlying disease often is associated with a decreased immune response such as metastatic malignant diseases and haemopathies. The first aetiology of inflammatory ulcerative skin lesions associated with TICVAD insertion
is thus usually assumed to be bacterial infection [1]. However, the differential diagnosis of these skin lesi
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