Perianal pyoderma gangrenosum

A 68-year-old male patient came to the emergency room due to an ulcer lesion in the perianal region. Physical examination revealed an 8 × 4.3 cm ulcer with surrounding erythema and central necrosis (Fig. 1). The biopsy specimen was identified as pyoderma gangrenosum (PG).

Figure 1

The location of PG in the perianal region has been very seldom reported in the literature, and it is sometimes a challenge to differentiate this entity from necrotizing fasciitis. Correct diagnosis is essential to initiate the appropriate treatment and prevent unnecessary surgical debridement, which can lead to pathergy and aggravate the situation. In the end, our patient responded to treatment with adalimumab 40 mg/week (Fig. 2).

Figure 2