An Unusual Presentation of Blastomycosis-Like Pyoderma Gangrenosum

Richard Simman, MD, FACS, FACCWS; Darren Gordon, PhD; Mary Steven, DNP; Amy Lynn, MD


Wounds. 2021;33(8):203-206. 

In This Article

Abstract and Introduction


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.


Pyoderma gangrenosum (PG) is a rare, neutrophil-mediated ulcerative cutaneous disorder characterized by painful skin ulcerations.[1] The estimated incidence of PG is about 3 to 10 cases per 1 million people per year.[2,3] Most cases are associated with underlying systemic disease (eg, inflammatory bowel disease [IBD]), and females are affected more often than males. Typically, PG presents as an ulceration of the skin with a central area of necrosis surrounded by inflammatory cell infiltrates. Management of PG mainly includes topical or systemic anti-inflammatory treatment and wound care.[4] The unclear presentation of PG warrants consideration of many varied diseases before making a final diagnosis of PG, which is usually a diagnosis of exclusion.[5]

Several subtypes of PG exist, and the ulcerative subtype is the most common and classical presentation. The other subtypes include periosteal, vegetative, bullous, and pustular forms.[4] Therefore, this complex cutaneous disease can present with many clinical features, suggesting the need for an exhaustive history and a physical to consider differential diagnosis to rule out other pathologies. Herein, the authors explore an atypical presentation of PG that at different stages of treatment mimicked various other cutaneous diseases including maligancy. Owing to the varied methods of optimal treatment of cutaneous diseases based on the etiology, careful consideration is necessary to make the correct diagnosis.