An Unusual Presentation of Blastomycosis-Like Pyoderma Gangrenosum

Abstract

Introduction. Pyoderma gangrenosum (PG) is a complex disease that has the potential to mimic a wide variety of diseases and disorders. Pyoderma is a disease of exclusion, but it has many variants, including ulcerative, bullous, and pustular forms. Owing to the complexity of the disease, careful diagnosis is important because inappropriate treatment can result in wound recurrence. Case Report. A 74-year-old female presented to the clinic with a presumed diagnosis of squamous cell carcinoma on biopsy but with an abnormal presentation mimicking a blastomycosis lesion. After surgical excision of the lesion in the operating room, the final pathology report confirmed the diagnosis of blastomycosis-like pyoderma gangrenosum. The patient was treated with high-dose prednisone and skin grafts, which resulted in resolution of the wound. Conclusions. This case report highlights the need to involve a wide array of health care providers in the management of complex and recurring wounds as well as the need to consider a wide and diverse differential diagnosis when determining the final diagnosis of complex wounds.