Both pyoderma gangrenosum (PG) and ecthyma gangrenosum (EG) manifest gangrenous lesions with black eschar. While PG is a noninfectious neutrophilic dermatosis, EG is an infectious occlusive vasculitis usually associated with Pseudomonas bacteraemia. We report a 78‐year‐old man with an unusual case of IgA‐κ gammopathy‐associated PG (Figs 1 and 2) complicated by EG in association with Alcaligenes xylosoxidans bacteraemia and P. aeruginosa wound infection (Figs 3 and 4). EG occurring during the course of PG can pose a great challenge for diagnosis and treatment. Sudden onset of necrotic eschar in a healing ulcer of PG should raise suspicion for EG or other gangrenous infections and prompt a repeated skin biopsy and cultures for bacteria and fungi.
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Yang et al. (2004) studied this question.