Non-healing ulcer after breast surgery in a patient with granulomatosis with polyangiitis

Postoperative pyoderma gangrenosum (PPG) is a rare subtype of pyoderma gangrenosum that occurs at surgical sites. A ۴۶-year-old woman presented with a non-healing ulcer at the site of a recent breast lift surgery. She had been diagnosed with granulomatosis with polyangiitis (GPA) in September ۲۰۱۷. After induction therapy with cyclophosphamide and prednisolone, and maintenance therapy with azathioprine, she remained in medication-free remission for ۴۰ months, until she underwent elective breast lift surgery. She developed non-healing ulcer at the site of breast lift surgery with severe pain. Over the following weeks, the surgical wound failed to heal despite standard post-operative care. Upon evaluation, laboratory tests revealed hematuria, leukocytosis, high acute phase reactants, and a markedly elevated cytoplasmic anti-neutrophil cytoplasm antibodies titer of ۱۰۰ IU/mL (normal < ۱۸). Induction therapy was initiated with prednisolone at ۱ mg/kg/d and rituximab ۲ g. Within ۲ to ۴ weeks, the patient experienced a dramatic reduction in wound pain, and the surgical site began to show signs of healing.

کلیدواژه ها:

Postoperative pyoderma gangrenosum ، pyoderma gangrenosum ، Granulomatosis with polyangiitis ، anti-neutrophil cytoplasm antibodies-associated vasculitis ، Surgery