Pyoderma gangrenosum (PG) is a rare autoinflammatory neutrophilic
dermatosis clinically characterized by painful nodules, red papules or plaques that rapidly erode into
ulcers. We report a 53-year-old febrile male patient with acute
peripheral arterial disease who underwent transtibial
amputation after failed thrombolysis. Five days after
amputation, an
ulcer developed around the cannulation site of the right internal jugular vein that was indicative of pathergy. The patient's
fever did not improve after surgery, and purpuric discoloration and punctate
ulcers of the skin near the
amputation site became apparent, leading to re-
debridement. Finally, consultation with a dermatologist raised the possibility of postoperative PG, and additional laboratory tests revealed positive
anticardiolipin autoantibodies consistent with
antiphospholipid syndrome. The patient was treated with intravenous glucocorticosteroids and
antibiotics, and the
amputation wound and cannulation site
ulcer were found to have healed at the 2-month follow-up. The current report raises the need for vascular surgeons to be aware of this uncommon etiology of arterial
thrombosis, and the postoperative appearance of
dermatosis and pathergy should alert for PG.