Pyoderma gangrenosum mimicking suppurative lymphadenitis in the neck of an adolescent

Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis often associated with underlying comorbidities such as inflammatory bowel disease (IBD). Classically lesions present on the lower extremities as painful, erythematous bullae or pustules, often at sites of prior trauma that rapidly expand to form deep, violaceous ulcers with a necrotic base. We present an unusual case of PG occurring on the neck of a 14-year-old boy with a history of IBD. While pediatric PG is uncommon, an adolescent with IBD who presents with a painfully expanding skin lesion following local trauma should raise suspicion for the diagnosis of PG, particularly if work-up reveals sterile dermal neutrophilia. Steroids are the mainstay of treatment, and care should be taken to avoid excess wound manipulation as pathergy phenomenon can exacerbate disease progression. Early involvement of a dermatologist is essential for facilitating prompt diagnosis and treatment, which may be initiated empirically in hopes of avoiding excess cribiform scarring.