Pyoderma gangrenosum–like lesion in an older adult

Pyoderma gangrenosum (PG) is a rare but serious neutrophilic dermatosis characterized by ulcerative lesions with violaceous borders. The disease mainly occurs in young or middle-aged adults. The authors present the case of a 79-year-old female nursing home patient who had an idiopathic PG-like ulcer on her lower extremity. Initial treatment with 3 courses of antibiotics and topical wound care for assumed cellulitis failed to improve the lesion, but the ulcer healed rapidly after a 1-week course of prednisone therapy (15 mg/d). This case provides insights into the challenges that arise in the diagnosis and management of PG in an older patient with extensive comorbidities. It also highlights the importance of considering PG as a diagnosis for older patients with a distinctive inflammatory ulcer that does not respond to antibiotics and topical wound care, since timely treatment with low-dose steroids can lead to quick healing by aborting the underlying autoinflammatory process.