We agree with Dr. Mitchell’s comment on our case report that critique is a part of the scientific process. To elaborate on our brief report, the patient was referred to the academic dermatology service for a presumptive diagnosis of pyoderma gangrenosum. Despite the clinical presentation of the ulcers not being classic for pyoderma gangrenosum, the patient was treated aggressively for this condition in hospital with high-dose steroids for more than a month, antibiotics, and increasing doses of cyclosporine as a steroid-sparing agent, as well as intensive wound care. No substantial improvement occurred in this patient with this aggressive treatment, and the small improvements that were seen were most likely due to secondary infection responding to the antibiotics. The disease course was clearly not typical of pyoderma gangrenosum as a decreased ulcer size within 1 month of starting immunosuppressive medications was expected (a diagnostic criterion of pyoderma gangrenosum).
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