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Thorac Cardiovasc Surg 2023; 71(01): 53-61
DOI: 10.1055/s-0041-1735960
Original Cardiovascular

Pyoderma Gangrenosum after Cardiac Surgery

Asen Petrov
1   Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
,
Utz Kappert
1   Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
,
Torsten Schmidt
2   Department of Cardiac Anesthesiology, University Heart Center Dresden, Dresden, Germany
,
Klaus Ehrhard Matschke
1   Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
,
Manuel Wilbring
1   Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
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Abstract

Background Pyoderma gangrenosum after cardiac surgery is a rare, noninfectious ulcerating skin disease mimicking sternal wound infection.

Methods A systematic search of literature for pyoderma gangrenosum complicating cases of cardiac surgery was conducted between September 1985 and September 2020 on PubMed and Cochrane databases. A systematic review and detailed overview of clinical presentation, diagnostic, treatment, and outcome is provided.

Results A total of 15 studies enclosing 15 patients suffering from pyoderma gangrenosum following cardiac surgery were identified. Onset of symptoms was observed after a median of 5 days. Patients were predominantly male (81.3%) with a median age of 64 years. Typical clinical presentation mimicked sternal site infection, mainly by means of mediastinitis. Specific signs were rapid progression, erythematous to violaceous color of the wound border, accompanied by unspecific symptoms including fever, malaise, and severe pain. Additionally, pathergy (development of ulcers at the sites of minor cutaneous trauma) was reported frequently. Biopsy is mandatory with a cutaneous neutrophilic inflammation confirming the diagnosis. Initial treatment mostly (75.0% of reported cases) was misled, addressing suspicion of surgical site infection. After correct diagnosis, the treatment was switched to an immunosuppressive therapy. Full sternal wound closure took between 5 weeks and 5 months. Reported case mortality was 12.5% in actually low-risk surgeries.

Conclusion Despite pyoderma gangrenosum has typical signs, it remains an exclusion diagnosis. The treatment is completely opposite to the main differential diagnosis—the typical surgical site infection. Knowledge about diagnosis and treatment is essential in the context of avoiding fatal mistreatment.

Keywords

immune - wound healing - wound infection

Supplementary Material



Publication History

Received: 04 April 2021

Accepted: 21 June 2021

Article published online:
11 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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