Seven patients underwent surgical interventions while on immunosuppressive therapy. Five patients had minor debridement of their wounds, one patient had split skin grafts (SSG), and another

had both SSG and minor debridement. None of the patients had exacerbation after these procedures. Intravenous antibiotics were administered to 18 patients http://www.selleckchem.com/products/MLN8237.html based on clinical suspicion of infected PG wound. 3.5. Patient Outcomes 3.5.1. Length of Stay (LOS) Mean length of hospital stay (LOS) till discharge or death was 47 days (range 5 to 243 days). Three patients were hospitalised for more than three months. All three suffered from concomitant wound infections during their hospital stay. Two of them grew Staphylococcus aureus and one grew Extended-spectrum beta-lactamase (ESBL) Escherichia coli. All three patients had abnormally high CRP levels (range 53mg/L–178mg/L) and one patient

who also suffered from colorectal cancer died during the initial hospital admission. 3.5.2. Death Five patients (21.7%) died during their initial hospital stay (see Table 2). Their mean age at time of admission was 78.8 years (range 72 to 85 years). The mean LOS till death was 50.6 days (range 15 to 151 days). All had lower limb PG. The cause of death was sepsis in four patients while one patient died of multiorgan failure secondary to hypovolemia. Four patients had ulcerative and one had vegetative PG. All patients had positive wound cultures and all had highly elevated CRP levels above 50mg/L. Four patients had associated systemic disease. All underwent systemic therapy: three had combination therapy while two had monotherapy. Table 2 Characteristics of patients who died during initial admission. 3.5.3. Recurrence Seven patients had recurrence of PG requiring readmission (see Table 3). The mean number of readmissions for PG was three (range 1 to 7). Three patients died during their subsequent admissions. The mean age at diagnosis of the patients who died during subsequent admissions was 68 years. Of those who died, two patients had concomitant

gastrointestinal disorders. Table 3 Characteristics of patients who survived initial admission. 4. Discussion 4.1. Patient Demographics We retrospectively reviewed 23 patients diagnosed with PG and treated at our hospital over a 10-year period. The mean age of onset was 62.8 years which was similar to that reported in two recent studies [11, 12]. Three earlier studies reported an earlier mean age of onset with Anacetrapib peak incidence in the fifth to sixth decade [13–15]. It is widely known that PG has a predilection for females [3] and our study has shown a similar result. 4.2. Clinical Features Four variants have been described in the literature, namely, ulcerative [2], vegetative [16], bullous [6], and pustular [17]. Ulcerative PG, which is the classical variant, is the commonest form in our study as well as previous studies [11–15, 18].