Pyoderma Gangrenosum Masquerading as Necrotizing Fasciitis: Stepping Away from Cognitive Shortcuts

  • Rachael Hilton Presbyterian/St. Luke's Medical Center, Denver, CO Medical University of South Carolina, Charleston, SC
  • Jefferson Berryman Presbyterian/St. Luke's Medical Center, CO University of California, Davis, CA
  • Karina Handoyo Presbyterian/St. Luke's Medical Center University of Colorado Hospital
Keywords: pyoderma gangrenosum, necrotizing fasciitis, anchor bias


A patient with post-Cesarean wound complication was treated for necrotizing fasciitis (NF) with sharp debridement and broad-spectrum antibiotics. Several operations and three weeks later, her abdominal skin, subcutaneous fat, right-sided rectus abdominus, and underlying fascia had been removed without any improvement in granulation tissue. Original pathology samples demonstrated sheets of necrosis consistent with NF, but were re-reviewed by a dermatopathologist who diagnosed the patient with pyoderma gangrenosum (PG). She was started on high-dose steroids and dapsone, and her wound quickly showed signs of improvement. Anchor bias delayed the initiation of steroids and diagnosis of PG as the surgical, medical, and consulting teams were hesitant to stray from the diagnosis of NF.

Author Biographies

Jefferson Berryman, Presbyterian/St. Luke's Medical Center, CO University of California, Davis, CA
PGY2 Ophthalmology Resident
Karina Handoyo, Presbyterian/St. Luke's Medical Center University of Colorado Hospital

Internal Medicine Attending Physician


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  • Published: 2017-09-28

    Issue: Vol 4 No 7 (view)

    Section: Articles

    How to cite:
    Hilton, R., Berryman, J., & Handoyo, K. (2017). Pyoderma Gangrenosum Masquerading as Necrotizing Fasciitis: Stepping Away from Cognitive Shortcuts. European Journal of Case Reports in Internal Medicine, 4(7).