(CS-127) Pyoderma Gangrenosum Like Presentation of Venous Leg Ulcers: A Retrospective Case Series

Friday, April 10, 2026

Jack Lucas, MS3; Hannah Gandy, MS3; Nirosha Adepu, MD; Poornema Ramasamay, MD

Introduction: The development of venous leg ulcers (VLUs) is a complex process, primarily driven by chronic venous insufficiency (CVI), which leads to microcirculatory damage and eventual ulceration. The potential intersection between these chronic ulcers and the pathological features of pyoderma gangrenosum (PG) creates a novel diagnostic and therapeutic challenge. This retrospective case series reports experiences with patients diagnosed with VLUs, attributed to venous stasis or lymphedema, and their sudden wound deterioration, with PG-like pathophysiology and presentation. In patients being treated for vascular leg ulcers (VLUs) with sudden deterioration, we propose that there is a novel inflammatory cascade, that acts like PG and warrants early recognition to allow for anti-inflammatory measures to be taken to allow for proven VLU treatments like compression therapy and debridement.

Methods: We present a series of cases where patients being treated for chronic venous leg ulcers (VLUs) developed a pyoderma gangrenosum (PG) like transformation of their wounds, which led to rapid deterioration and progression of their wounds.

Results: There were seven patients that we have  followed over the course of their treatments in the wound clinic and have found that routine treatment for VLU were not sufficient for these patients, however once immunologic therapy was started for them recovery improved. These patients are not truly PG as they do not require ongoing immunologic therapy. We found that their disease course was similar to PG, indicating a proinflammatory process that was similar.

Discussion:

In conclusion, we are trying to describe pyoderma type transformation that clinicians should be able to identify in VLU. Early identification will improve patient outcomes, and understanding different treatment modalities will assist with more efficient recovery.