Weenig RH, Davis MD, Dahl PR, Su WP, et al.
The New England journal of medicine. Date of publication 2002 Oct 31;volume 347(18):1412-8.
1. N Engl J Med. 2002 Oct 31;347(18):1412-8.
Skin ulcers misdiagnosed as pyoderma gangrenosum.
Weenig RH(1), Davis MD, Dahl PR, Su WP.
Author information:
(1)Department of Dermatology, Mayo Clinic, 200 First St., SW, Rochester, MN
55905, USA.
Comment in
N Engl J Med. 2003 Mar 13;348(11):1064-6; author reply 1064-6.
N Engl J Med. 2003 Mar 13;348(11):1064-6; author reply 1064-6.
BACKGROUND: Pyoderma gangrenosum is a diagnosis of exclusion, and the
misdiagnosis of pyoderma gangrenosum can result in substantial complications in
patients who have other causes of severe cutaneous ulceration.
METHODS: We reviewed the charts of 240 patients with a diagnosis of pyoderma
gangrenosum who were evaluated at our institution from 1975 through 2000,
including 157 consecutive patients treated for presumed pyoderma gangrenosum from
1984 through 1992. We also reviewed the English-language literature.
RESULTS: Ninety-five patients (49 from our institution and 46 described in the
literature) had skin ulcers with a clinical resemblance to pyoderma gangrenosum.
The final diagnoses were vascular occlusive or venous disease, vasculitis,
cancer, primary infection, drug-induced or exogenous tissue injury, and other
inflammatory disorders. Of the 95 patients studied, 64 had been treated for
pyoderma gangrenosum for a median of 10 months (range, 3 to 180). These 64
included 15 of the 157 consecutive patients treated for pyoderma gangrenosum at
our institution (10 percent). Of the ulcers in the 64 patients treated for
pyoderma gangrenosum, it was clear that those in 23 patients (36 percent) did not
respond to treatment directed at pyoderma gangrenosum, those in 8 (12 percent)
were exacerbated by such treatment, and those in 15 (23 percent) improved with
such treatment.
CONCLUSIONS: The misdiagnosis of pyoderma gangrenosum is not uncommon and exposes
patients to risks associated with its treatment. A thorough evaluation is
required in all patients suspected of having pyoderma gangrenosum in order to
rule out alternative diagnoses.
Copyright 2002 Massachusetts Medical Society
DOI: 10.1056/NEJMoa013383
PMID: 12409543 [Indexed for MEDLINE]
