Pyoderma gangrenosum of the breast in a patient with a history of silicone augmentation mastopexy and suction-assisted lipectomy of the trunk.

PG: pyoderma gangrenosum CASE REPORT A 22-year-old woman with no history of autoimmune disease, inflammatory bowel disease, or malignancy presented to the emergency department with well-demarcated erythema of both breasts, right worse than left. Five days before she underwent cosmetic bilateral augmentation mastopexy with 150-mL smooth round silicone gel implants and suction-assisted lipectomy of the anterior and posterior trunk and thighs, receiving appropriate perioperative antibiotic prophylaxis with a firstgeneration cephalosporin. Sites of liposuction were not affected. Erythema began on the third day after the operation, advancing from the lower pole of each breast to the inferior nipple progressing to wound dehiscence and destruction, with bloody, purulent drainage. Erythema was accompanied by fever (40.58C), headache, increased C-reactive protein level, elevated platelet level, and left-shift leukocytosis. She had negative serologies for antinuclear antibodies, anticytoplasmic neutrophil antibodies and rheumatoid factor. Thyroid function tests and serum glucose were within normal limits. She underwent emergency surgery to remove both implants, debridement and irrigation of necrotic wounds with antibiotic solution, and placement of bilateral drains; samples for culture were collected (Fig 1). Preliminary diagnosis was severe cellulitis and acute breast implant infection after augmentation mastopexy. Despite infectious disease consultation and the commencement of vancomycin, daptomycin, clindamycin, cefepime, and micafungin,