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Alsawadi A. 1, Abbas M. 1, Fraser-Andrews E. 2, Suresh S. P. 1
1 Department of Orthopedic and Trauma Surgery, Colchester Hospital University NHS Foundation Trust, Colchester, UK;
2 Department of Dermatology, Colchester Hospital University NHS Foundation Trust, Colchester, UK
Pyoderma gangrenosum (PG) is an uncommon dermatological inflammatory condition characterised by cutaneous ulceration. It is known to be associated with some systemic diseases but up to 40% of cases present without any associated condition. It may occur at sites of trauma but has not been previously reported at the site of influenza vaccination. If presented to clinical team unfamiliar with PG, it may be misdiagnosed as infection or treated with surgical debridement, which is potentiality dangerous. We present an elderly man admitted under orthopaedic team with left upper arm ulceration and erythema for eleven weeks after receiving a flu vaccine injection. He was treated with intravenous antibiotics and underwent several radiological studies. When he failed to respond to the treatment a dermatology opinion was sought and the diagnosis of PG was made and steroid treatment was commenced. The rarity of the condition and the fact that the diagnosis is predominantly based on the clinical features make the diagnosis difficult when presenting to clinical teams unfamiliar with PG. Understanding the nature of the condition, its clinical presentation, and early referral to the dermatologist avoids unnecessary investigation and potentially dangerous surgical intervention.