Abstract
Pyoderma gangrenosum (PG) is a rare and painful skin disease with unpredictable treatment response. The lesions are recurrent and occur in areas that have suffered previous trauma. Some cases have been related to different types of surgeries and it is usually underdiagnosed and erroneously classifi ed as an infectious process. The implantation of a neurostimulation system is a surgical procedure with several possible complications, usually infectious but also non-infectious such as hypersensitivity reactions but there is no description of PG. We report a patient with a post-surgical complex regional pain syndrome in both feet that develops a necrotic, pustular, erythematous and painful lesion after the implantation of a spinal cord stimulation which was diagnosed as PG and correctly treated thanks to a multidisciplinary approach.References
1. Reichrath J, Bens G, Bonowitz A, Tilgen W. Treatment recommendations for pioderma gangrenosum: an evidence-based review of the literature based on more than 350 patients. J Am Acad Dermatol. 2005;53(2):273-83. DOI: 10.1016/j.jaad.2004.10.006.
2. Miller J, Yentzer BA, Clark A, Jorizzo JL, Feldman SR. Pyoderma gangrenosum: a review and update on new therapies. J Am Acad Dermatol. 2010;62(4):646-54. DOI: 10.1016/j.jaad.2009.05.030.
3. Ruocco E, Sangiuliano S, Gravina AG, Miranda A, Nicoletti G. Pyoderma gangrenosum: an up dated review. J Eur Acad Dermatol Venereol. 2009;23(9):1008-17. DOI: 10.1111/j.1468-3083.2009.03199.x.
4. Ahronowitz I, Harp J, Shinkai K. Etiology and management of pyoderma gangrenosum: a comprehensive review. Am J Clin Dermatol 2012;13(3):191-211. DOI: 10.2165/11595240-000000000-00000.
5. Su WP, Davis MD, Weenig RH, Powell FC, Perry HO. Pyoderma gangrenosum: clinic pathological correlation and proposed diagnostic criteria. Int J Dermatol 2004;43(11):790-800. DOI: 10.1111/j.1365-4632.2004.02128.x.
6. Cozzani E, Gasparini G, Parodi A. Pyoderma gangrenosum: a systematic review. G Ital Dermatol Venereol. 2014;149(5):587-600.
7. Zuo KJ, Fung E, Tredget EE, Lin AN. A systematic review of post-surgical pioderma gangrenosum: Identification of risk factors and proposed management strategy. J Plast Reconstr Aesthet Surg. 2015;68(3):295-303. DOI: 10.1016/j.bjps.2014.12.036.
8. Bendersky D, Yampolsky C. Is spinal cord stimulation safe? A review of its complications. World Neurosurg. 2014;82(6):1359-68. DOI: 10.1016/j.wneu.2013.06.012.
9. Hoelzer BC, Bendel MA, Deer TR, Eldrige JS, Walega DR, Wang Z, et al. Spinal cord stimulator implant infection rates and risk factors: a multicenter retrospective study. Neuromodulation. 2017;20(6):558-62. DOI: 10.1111/ner.12609.
10. Delaplace M, Maître F, Dufour T, Landrieux I, Gauthier P, Jebira P, et al. Two cases of cutaneous erythema following spinal cord stimulation. Ann Dermatol Venereol. 2010;137(4):297-300. DOI: 10.1016/j.annder.2010.02.017.
11. Chaudhry ZA, Najib U, Bajwa ZH, Jacobs WC, Sheikh J, Simopoulos TT. Detailed analysis of allergic cutaneous reactions to spinal cord stimulator devices. J Pain Res. 2013;6:617-23. DOI: 10.2147/JPR.S44676.
