Abstract
Pyoderma gangrenosum (PG) is a rare, immune-mediated neutrophilic dermatosis, presenting with painful ulcerative skin lesions. These lesions often start as pustules on an erythematous base, progressing to large ulcers with purulent edges. Diagnosing PG can be challenging, as it lacks definitive tests and requires exclusion of other conditions, including infections and vascular diseases. PG is frequently associated with systemic autoimmune diseases such as inflammatory bowel disease, rheumatoid arthritis, and monoclonal gammopathies. This report describes a case of a 40-year-old Hispanic male patient with recurrent, painful lesions on his lower extremities. Initially misdiagnosed as cellulitis, the patient had a complex history of peripheral vascular disease, which added to the diagnostic difficulty. The patient's history of recurrent ulcerations, persistent post-inflammatory hyperpigmentation, and rapid response to corticosteroids led to a clinical diagnosis of PG. This case highlights the need for careful differential diagnosis in chronic, non-healing lesions, emphasizing that PG should be considered, particularly in atypical presentations or in patients without common systemic associations. Early recognition and immunosuppressive therapy are crucial to avoid misdiagnosis and improve patient outcomes.