Q: 34-year-old male with a known history of Ulcerative Colitis (UC) is admitted to ICU with severe abdominal pain and hypovolemic shock. Following is noted on his leg. Your diagnosis?

Answer: Pyoderma gangrenosum

Pyoderma gangrenosum is an ulcerative cutaneous condition and is a diagnosis of exclusion. It is found to be associated with malignancy, vasculitis, collagen vascular diseases, diabetes, trauma and others. The pitfall is to treat it as an infective process. Rather it requires anti-inflammatory agents including steroids, immunosuppressive agents, and biologic agents. Antibiotics are required only on superimposed infections.