Recurrent and treatment-resistant pyoderma gangrenosum, secondary to hidden underlying breast cancer

Abstract

Pyoderma gangrenosum (PG) is a rare ulcerative disorder of the skin associated with underlying diseases, such as rheumatoid arthritis, inflammatory bowel disease and hematological malignancies. However, there have been very few reports of association of PG with solid organ malignancies. We report here the case of a 37-year-old lady with a chronic non-healing ulcer of the thigh, who repeatedly underwent multiple debridements, followed by two failed grafts, which was later diagnosed as PG. Initially, she failed to respond to oral steroids, but responded well with intravenous methylprednisolone pulse. However, she later presented with a breast mass with bone metastasis and recurrence of PG ulcer. Diagnosis and treatment of the underlying occult malignancy along with that of PG at an initial stage would have prevented the recurrence and avoided a serious consequence like metastasis. The case study underscores the association of PG with serious conditions, such as malignancy, and the necessity to conduct prompt and thorough analysis in such cases.