A Case of Cervical Pyoderma Gangrenosum Arising from Left Purulent Parotitis

Abstract

A 77-year-old woman visited a nearby dentist with the main complaint of swelling of the left cheek. She was suspected of having left parotitis and antibiotic treatment was initiated ; however, there was no improvement. She was referred to the oral surgery department of our hospital. CT revealed significant enlargement of the left parotid gland, and the patient was hospitalized. The patient was diagnosed with purulent parotitis and underwent antibiotic treatment and drainage. However, as the skin ulcer from the drain insertion gradually expanded, daily debridement of the neck was performed. Despite this, the extent of necrosis continued to increase, and the patient was referred to our department. At the time of the first visit to our department, an irregular ulcer with a limbic embankment (11.5×8 cm) was observed on the left side of the neck. Klebsiella pneumoniae ssp. pneumoniae was detected in bacterial culture. Pathological examination of tissues from the ulcer margin revealed a high degree of neutrophil infiltration extending from the epidermis to the subcutaneous tissue. After a diagnosis of pyoderma gangrenosum, oral prednisolone (30 mg/day) and minocycline (200 mg/day) were initiated, leading to rapid ulcer contraction. Pyoderma gangrenosum occurring in the parotid gland and neck is rare. It is necessary for a dermatologist to intervene at an early stage to manage expanding ulcers. Skin Research, 24: 56-60, 2025