Case report demonstrates fatal disease progression in a patient with refractory pyoderma gangrenosum, highlighting the critical need for prompt diagnosis and effective systemic therapies.
Key Points
To describe a fatal case of ulcerative pyoderma gangrenosum that was refractory to multiple lines of non-steroidal systemic therapies after being initially misdiagnosed as a diabetic ulcer.
Clinical and therapeutic evaluation of a 68-year-old male presenting with painful, necrotic lower-extremity ulcers displaying pathergy and surrounding edematous erythema.
Sequential administration of systemic alternatives to corticosteroids—including adalimumab, granulocyte and monocyte adsorption apheresis, and cyclosporine—due to patient-specific contraindications.
Initial misclassification of lesions as diabetic ulcers caused treatment delays before characteristic signs confirmed pyoderma gangrenosum.
Sequential systemic therapies failed to arrest ulcerative progression, leading to continuous clinical decline and death 14 months after presentation (approximately 26 months after onset).