Pyoderma gangrenosum (PG) after
breast-conserving surgery is rare, and its diagnosis is often delayed because of the similarity to
wound infection and the broad differential diagnosis for PG, making it a diagnosis of exclusion. A 60-year-old woman who underwent
breast conserving surgery and sentinel lymph node biopsy for invasive
breast carcinoma presented with increasing
erythema,
fever and serosanguinous discharge in the lower outer quadrant of the right breast at the site of tumour excision on postoperative day (POD) 9.
Fever persisted despite
antibiotics and the patient was noted to have leucocytosis (0.9 x 109/L), neutrophilia (37.8 x 109/L) and elevated
C-reactive protein levels (136 μg/mL) on POD 16. Microbiology and blood culture results were negative but the breast
ulcer continued to expand at a rate of 1-2 cm a day. The patient underwent surgical
debridement on POD 21 to rule out necrotising
soft tissue infection. Persistent
ulcer progression, despite
debridement and
antibiotics, led to clinical suspicion of PG and the patient was started on
prednisolone and
cyclosporin. A rapid response was seen with treatment and an optimum healing process was noted over the subsequent three-month follow-up period. Early suspicion, careful macroscopic evaluation of
disease progression and appropriate use of immunosuppressive therapy are important for the management of PG. Prompt initiation of immunosuppressive therapy may avoid unnecessary treatment and aggravation of the
surgical wound.