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A 72-year-old woman underwent splenectomy for transfusion-dependent myelofibrosis, and rapidly advancing, nonhealing necrotic skin ulcers developed over the incision site on the eighth postoperative day (Panel A). The abdominal-wall ulcers were treated unsuccessfully with a broad-spectrum antibiotic. Multiple wound cultures remained negative for pathogens. A skin biopsy revealed neutrophilic inflammation involving the dermis. The skin was undermined by necrosis at the margins of the ulcer and showed reepithelialization (arrow in Panel B; hematoxylin and eosin, x4). No bacteria were seen, and atypical pyoderma gangrenosum (or neutrophilic dermatosis) was diagnosed. A two-month course of oral corticosteroids, in which the dose . . . [Full Text of this Article] |
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