Pyoderma gangrenosum (PG) is a neutrophilic dermatosis, defined by a pathological abundance of neutrophils in the absence of infection. Clinical presentation consists of a rapidly enlarging, painful ulcer, undermined violaceous borders and purulent cover. Post-surgical PG is rare but can occur in all kinds of surgeries, macroscopically mimic an infection of the operative site. It’s often the diagnosis of exclusion, requiring the investigation of infection and other causes of cutaneous ulcers before diagnosis. The goal is to present a case report of an 18-year old patient with difficult postoperative wound complication that required multidisciplinary teamwork. Young healthy female patient with history of post-operative complication sepsis and multi organ failure after patellofemoral ligament reconstruction developed PG after second reconstructive surgery. On 6th postoperative day she developed septic shock, on right thigh was 20x27cm wide ulcer covering skin and subcutaneous tissue, with mildly expressed livid margins and epidermolysis. Extensive secretion and extreme pain upon palpation was present.Treatment firstly began with different antibiotics due to septic shock and unimproved clinical picture with high laboratory levels of CRP and leukocytosis. Blood cultures and swab cultures showed no bacteria present, therefore we raised the suspicion of neutrophilic dysfunction. Histopathologic results showed suppurative dermatitis, vesicles filled with neutrophilic granulocytes in epidermis and epidermolysis. DIF, gram stain test and PAS method were negative, what made our diagnosis accurate. Treatment with intravenous and topical corticosteroids were initiated. As well known PG is a challenging skin condition that requires a multidisciplinary approach. There has been made many correlations in literature between PG and systemic inflammatory diseases, for which neutrophilic disfunction is a key element. Recently our patient developed Bechet’s disease. Though the relationship between PG and Bechet’s disease is not referred in diagnostic criteria of Bechet’s disease we stress the importance of keeping it in mind in further cases.

Keywords: Pyoderma gangrenosum, Postsurgical complication, Bechet’s disease.