Abstract

Background: Co-occurrence of pyoderma gangrenosum (PG) and ecthyma gangrenosum (EG) pose diagnostic and therapeutic challenges in immunocompromised patients.

Case Report: A 47-year-old Filipino woman with transfusion-dependent intermediate-risk myelodysplastic syndrome (MDS) was admitted to our institution for allogeneic hematopoietic stem cell transplantation (HSCT). During the preparation for allogeneic HSCT, she developed several erythematous ulcerated lesions on the lower extremities, which were initially managed as PG. Subsequent febrile episodes and worsening lesions with isolated Escherichia coli in blood and tissue cultures lead to the diagnosis of EG complicating PG. She was treated through targeted antibiotics, wound debridement, and proper wound care. After the resolution of the infection and upon starting low-dose immunosuppression followed by allogeneic HSCT, her left leg lesions showed progressive improvement. Six months after HSCT, lesions were completely resolved with complete epithelialization.

Conclusion: This case highlights the importance of accurate diagnosis and integrated management of complex conditions like PG and EG in immunocompromised patients. The successful resolution of lesions post-HSCT underscores the potential curative role of stem cell transplantation in managing MDS-associated PG.