摘要
Abstract
Objective To analyze the clinical manifestations,diagnosis and treatment of rare pyoderma gangrenosum(PG),and to discuss the causes and preventive measures of PG misdiagnosis.Methods The data of 2 patients with misdiag-nosed PG who had been treated from March 2022 to November 2023 were retrospectively analyzed.Results One patient was a middle-aged male,with multiple unexplained recurrent ulceration,pus discharge and pain,and a history of pulmonary tu-berculosis and elevated blood inflammatory factors.Combined with rapid pathological results during debridement,the patient was initially diagnosed as a tuberculous wound.Diagnostic anti-tuberculosis treatment was given but was not effective,and the symptoms were relieved after the addition of Glucocorticoid.After the pathological results were reported by consultation,he was diagnosed as PG through comprehensive analysis.The misdiagnosis lasted 15 d.The patient had a good prognosis after discontinuing antituberculosis drugs and receiving Glucocorticoid therapy.The other patient was an elderly female and presen-ted with recurrent nodules,ulceration,discharge and pain in both lower extremities and without special history.The initial di-agnosis was cellulitis in another hospital,which recurred after anti-infection and necrotic tissue removal treatment.The patient was admitted to our hospital as a furuncle,with elevated inflammatory factors and mild anemia through blood examination.No growth of bacteria,acid-fast bacilli,fungal spores and mycelia was found in wound secretions.Bacterial culture and tissue fungal culture were negative,and PG was confirmed by histopathological examination.The misdiagnosis lasted more than 1 year.After diagnosis,the patient was given anti-infection treatment combined with Glucocorticoid,and the prognosis was good.Conclusion The lesions of PG are varied in shape and lack specific laboratory detection indexes and pathological fea-tures,which is difficult to diagnose and prone to misdiagnosis.It is beneficial to the early diagnosis and treatment of the dis-ease to strengthen the understanding and attention of the receiving doctors,pay attention to the histopathological examination and strengthen the concept of multidisciplinary consultation.关键词
坏疽性脓皮病/误诊/结核性创面/蜂窝组织炎/疖肿/诊断/鉴别诊断Key words
Pyoderma gangrenosum/Misdiagnosis/Tuberculous wound/Cellulitis/Furuncle/Diagnosis/Differenti-al diagnosis分类
医药卫生
