PMC5771740_01
A, Pyoderma gangrenosum at admission with exposed tibialis anterior tendon. B, Edema and desiccation of the tibialis anterior tendon at follow-up. C, Granulation tissue development following debridement of the exposed tendon. D, Near resolution of the ulcer after 1 year of treatment with infliximab and minocycline.
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Pathergic expansion of the ulcer was noted at the site of punch biopsy on the ulcer's margin (Fig 1, A). At follow-up, exposure of the tibialis anterior tendon persisted, and the patient noted the tendon was turning black and painful, and she complained of difficulty with ipsilateral ankle dorsiflexion (Fig 1, B). Five days after the debridement, healthy-looking granulation tissue had developed over the tendon (Fig 1, C). The patient was followed by a dermatologist for over a year, and near complete resolution of the ulcer was observed with fully restored dorsiflexion and strength on infliximab and minocycline (Fig 1, D).