Postoperative pyoderma gangrenosum after spinal fusion with instrumentation: case report

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Pyoderma gangrenosum (PG) is a rare inflammatory dermatosis that is most often associated with inflammatory bowel disease, but which can occur as a pathergic reaction around surgical incisions. The authors report the case of a patient who developed postoperative PG over the course of several months after undergoing extensive spinal instrumentation between the T4 and iliac levels. This is only the second such case occurring after spine surgery to be reported. The authors additionally review the literature to characterize treatment approaches and outcomes for this condition. The case highlights a potentially severe adverse effect of surgery that can be difficult to recognize and causes delays in effective treatment. It also demonstrates the importance of multidisciplinary collaboration in the effective care of patients.

ABBREVIATIONS IBD = inflammatory bowel disease; PG = pyoderma gangrenosum; PPG = postoperative PG; RA = rheumatoid arthritis; RCT = randomized controlled trial; SSI = surgical site infection; vac = vacuum-assisted closure; WBC = white blood cell.
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Contributor Notes

Correspondence Avery L. Buchholz: University of Virginia Health System, Charlottesville, VA. alb8jp@virginia.edu.INCLUDE WHEN CITING Published online October 25, 2019; DOI: 10.3171/2019.7.SPINE19708.Disclosures Dr. Shaffrey reports direct stock ownership in NuVasive; being a patent holder for NuVasive, Medtronic, Zimmer Biomet, and SI Bone; and being a consultant to NuVasive, Medtronic, and SI Bone. Dr. Buchholz reports being a consultant to Medtronic, Siemens, and NuVasive.
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