22 September 2026
: Case report 
Dual-Site Postsurgical Pyoderma Gangrenosum of the Breast and Back With Delayed Diagnosis: A Case Report
Unusual clinical course, Challenging differential diagnosis
Tristan Packard ABCDEF 1*, Grant Dolan ABCD 2, Cathryn Chance BEF 1, Mark Jones ABDE 3DOI: 10.12659/AJCR.954079
Am J Case Rep 2026; 27:e954079
Table 1 Summary of clinical course after initial wound clinic evaluation.
| Time point after first wound clinic visit | Key clinical events |
|---|---|
| Week 0 | The patient presented to the wound clinic with a chronic nonhealing left superior breast ulcer after surgical treatment of a presumed benign lesion. The left lower back surgical site had initially healed but later became clinically relevant after reopening. Initial considerations included infection, impaired wound healing, retained cyst lining, foreign-body reaction, and implant-related complications |
| Weeks 1–16 | The breast wound persisted despite wound-directed therapy, including serial debridement, hyperbaric oxygen therapy, antimicrobial therapy, and advanced biologic wound products. During this period, the breast lesion enlarged, and the lower back wound reopened and began to enlarge |
| Weeks 17–34 | The diagnostic workup broadened because of progressive multifocal ulceration and pulmonary findings concerning for disseminated fungal infection. Antifungal therapy was initiated, and repeat evaluations continued to exclude malignancy, persistent infection, and foreign-body reaction. Despite antimicrobial and antifungal therapy, neither lesion demonstrated sustained improvement |
| Weeks 35–50 | Both lesions continued to enlarge despite ongoing wound care and repeated procedural intervention, raising concern for pathergy. By approximately week 50, the breast lesion measured 10.0 × 10.5 cm and the back lesion measured 2.0 × 2.5 cm. Postsurgical pyoderma gangrenosum became the favored diagnosis |
| Weeks 51–64 | Topical betamethasone 0.1% and intralesional triamcinolone were initiated, with repeat injections over the following weeks. Both lesions subsequently improved and completely resolved by approximately week 64 of treatment |