Delayed Presentation of Pyoderma Gangrenosum in Benign Breast Lumpectomy Case Report

 Introduction: Pyoderma Gangrenosum is an uncommon inflammatory condition, and is especially rare as a delayed presentation in the breast region.  It is often triggered by dermal injury such as surgical intervention or trauma, marked by very painful, rapidly advancing ulcers with erythematous violaceous borders. Pyoderma Gangrenosum can masquerade as postoperative wound infections, resulting in potential misdiagnosis and improper antibiotic treatment. Recognizing its distinct clinical features is crucial, especially in cases where breast ulcer spare the nipple areolar complex and are refractory to antibiotic therapy.Methods:we present the case of a patient with no significant medical history who developed Pyoderma Gangrenosum four months after undergoing breast lumpectomy for benign disease. Our treatment approach involved a combination of local wound care using alginate, collagen, and topical agents, alongside immunosuppressive therapy starting with prednisone and topical Clobetasol, progressing to cyclosporine, resulting in resolution.  Results:Pyoderma Gangrenosum is a challenging diagnosis especially when it presents in atypical locations such as breasts with out any contributing  medical history.  It should be part of the differential diagnosis of a non healing, rapidly progressive , extremely painful  surgical wound of the breast that spare  the nipple areolar complex. Typically, bacterial cultures yield negative results, and neutrophils are observed in the wound. Patient are referred to wound care, however these ulcers worsen with debridement. Pyoderma Gangrenosum frequently responds to a combination of local wound care and immunosuppressive therapy, leading to symptom resolution and ulcer improvement.Discussion: As though delayed presentation  of Pyoderma Gangrenosum post operative  especially in the breast is uncommon, it requires a high index of suspicion, and meticulous work up. Patients are often are referred to wound care center for evaluation and treatment. Various wound care products are employed, tailored to the specific characteristics of the wound,  in conjunction with immunosuppressive therapy. By shedding light on the clinical presentation, diagnosis, and management of Pyoderma Gangrenosum in the breast region, we aim to enhance awareness and facilitate prompt recognition and appropriate management of this rare but debilitating condition.References: