Zhao Y, Fang RY, Feng GD, Cui TT, Gao ZQ. Pyoderma gangrenosum confused with congenital preauricular fistula infection: A case report. World J Clin Cases 2020; 8(9): 1679-1684 [PMID: 32420301 DOI: 10.12998/wjcc.v8.i9.1679]
Corresponding Author of This Article
Zhi-Qiang Gao, MD, Chief Doctor, Director, Professor, Surgeon, Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China. gzqent@163.com
Research Domain of This Article
Otorhinolaryngology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 6, 2020; 8(9): 1679-1684 Published online May 6, 2020. doi: 10.12998/wjcc.v8.i9.1679
Pyoderma gangrenosum confused with congenital preauricular fistula infection: A case report
Yang Zhao, Rou-Yu Fang, Guo-Dong Feng, Ting-Ting Cui, Zhi-Qiang Gao
Yang Zhao, Guo-Dong Feng, Ting-Ting Cui, Zhi-Qiang Gao, Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Rou-Yu Fang, Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Author contributions: Zhao Y, Cui TT and Feng GD were the patient surgeons, reviewed the literature and contributed to manuscript drafting; Fang RY was the consulting dermatologist and analyzed and interpreted the pathology; Gao ZQ directed the diagnosis and reviewed the literature; and all authors approved the final version for submission.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhi-Qiang Gao, MD, Chief Doctor, Director, Professor, Surgeon, Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China. gzqent@163.com
Received: January 6, 2020 Peer-review started: January 6, 2020 First decision: March 18, 2020 Revised: March 22, 2020 Accepted: April 4, 2020 Article in press: April 4, 2020 Published online: May 6, 2020 Processing time: 115 Days and 4.7 Hours
Abstract
BACKGROUND
Pyoderma gangrenosum resulting from or associated with congenital preauricular fistula is rarely reported.
CASE SUMMARY
We report a rare case of pyoderma gangrenosum misdiagnosed as preauricular fistula infection. To our knowledge, this is the first report to describe pyoderma gangrenosum originating from the site of preauricular fistula. The lesion continued expanding even after combined treatment of systemic antibiotics and thorough debridement. Taking into account the possibility of pyoderma gangrenosum, we applied soft care with normal saline and Vaseline gauze dressing. Systemic corticosteroids were not used until intestinal Clostridium difficile was controlled. No local recurrence was noted at the 12-mo follow-up.
CONCLUSION
This case highlights the necessity of considering rare diseases, such as pyoderma gangrenosum, when the preauricular sinus deteriorates with general management. The treatment strategy is mutually conflicting between pyoderma gangrenosum and infection of the preauricular sinus.
Core tip: Acute infection of the preauricular sinus is common in clinical practice, while pyoderma gangrenosum is rare. We here report a rare case of pyoderma gangrenosum that was initially treated as common preauricular sinus infection and did not respond to traditional management. Pyoderma gangrenosum is a noninfectious inflammatory dermatosis that presents as an inflammatory disorder of the skin. The most common comorbidity is inflammatory bowel disease. Diagnosis of pyoderma gangrenosum should be considered when standard management is not effective or it is complicated with inflammatory bowel diseases.
