PMC3970922_01
(A) Sacral pyoderma gangrenosum after multiple debridements. (B) Huge abdominal and left thigh wound defect with typical violaceous borders post-debridement.
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After the third debridement, the abdominal ulcer had increased to a size of 32 cm x 11 cm, and the two sacral ulcers became a huge sacral defect extending into the perianal region (Figure 1A and B).
Histology of incisional biopsy of abdominal ulcer. (A) Extensive skin ulceration is shown (H&E stain; original magnification x10). (B) Higher-powered view of ulcer being covered by inflamed crust and infiltrated by a heavy collection of acute inflammatory cells (neutrophils) (H&E stain; x20).. Abbreviation: H&E, hematoxylin and eosin.
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Repeated histological sections of sacral and abdominal tissues revealed neutrophilic infiltrates extending into deep dermis and no evidence of malignancy (Figure 2A and B).
After treatment with immunosuppressive medications, appearance of sacral (A) and abdominal and left thigh (B) pyoderma gangrenosum.
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Four months after admission, the patient underwent successful split skin grafts and primary closure to her abdominal and sacral ulcers while on immunosuppressive therapy (Figure 3A and B).