Pyoderma Gangrenosum Masquerading as Necrotizing Infection after Autologous Breast Reconstruction

Pyoderma gangrenosum (PG) is a diagnostic dilemma when it presents with a superimposed infection and previous surgery without subsequent inflammatory infection. In this setting, PG is not at the forefront of the surgeon's mind. Furthermore, the treatment for PG, systemic steroids, may cause serious morbidity if the necrotizing infection is the actual culprit. We present an autologous breast reconstruction patient with previous uncomplicated surgery and no personal history of inflammatory disease. Important clinic clues to aid the surgeon in diagnosis include irregular violaceous undermined border, purulence limited to the skin, bilateral involvement, the involvement of the abdominal wound, sparing of the mastectomy site, and relative sparing of the nipples and umbilicus.