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Pyoderma Gangrenosum - a Feasible Option in the Differential Diagnosis of Soft Tissue Gangrene in Diabetic Patients?

Elina Merashka, Victor Iliev, Teodora Nikolova, Gulay Ahmedova, Vasil Dimitrov, Emil Filipov


Introduction: Soft tissue gangrene is a severe and life-threatening complication of diabetes. It is usually caused by a previous injury and following bacterial contamination and infection. In some cases the wound specimens show no bacterial presence so that some, more rare conditions must be taken into consideration.

Materials and Methods: We have conducted a histological study, immunological study, and a microbiological analysis of wound samples.

Results: We present a clinical case of a 57-year-old diabetic male patient with signs of hard-to-heal ulceration on the left shank which extends its borders after surgical treatment and the wound surface is covered with multiple microabscesses. The multiple microbiological analyses of the wound exudate are negative. After conducting immunological and histological analysis the patient is diagnosed with pyoderma gangrenosum.

Conclusion: Hard-to-heal wounds with deteriorated local status after surgical treatment in diabetic patients must be assessed after precisely performed clinical studies and differential diagnosis must be expanded in order to include autoimmune diseases.


hard-to-heal wounds, pyoderma gangrenosum, diabetes



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