Pyoderma gangrenosum as a rare manifestation of myelodysplastic syndrome in a pediatric patient: A case report

Pyoderma gangrenosum is a rare neutrophilic dermatosis that presents as rapidly progressive ulcerative lesions, often associated with systemic diseases. Pyoderma gangrenosum remains an uncommon and challenging diagnosis particularly in a pediatric population. We report a 3-year-old male with myelodysplastic syndrome who developed a nonhealing ulcer of the right forearm following minor trauma. The lesion was misdiagnosed as an infection, leading to prolonged antibiotic therapy. The patient underwent surgical debridement and closure of the ulcer with bilateral advancement flaps with biopsies taken. However, the wound dehisced and ulcerated. Due to the progressive nature and lack of response to antimicrobials, pyoderma gangrenosum was suspected and later confirmed through clinical and histopathologic findings. The patient demonstrated significant clinical improvement with 2 months of topical and systemic corticosteroid therapy. This case highlights the challenges of diagnosing pyoderma gangrenosum in pediatric populations, and the utility of histology in management, given the low index of suspicion in children.