Multi-organ pyoderma gangrenosum presenting as refractory prostatitis

We report a rare case of concurrent cutaneous and prostatic pyoderma gangrenosum (PG) in a man in his 70s. The patient initially presented with dysuria, pelvic discomfort and a boggy prostate, consistent with bacterial prostatitis. Despite prolonged antibiotic therapy, his symptoms progressed and imaging revealed a prostatic abscess. Following transurethral resection of the prostate, he developed painful necrotic ulcers across the trunk and extremities. Histopathological examination of both the prostate and skin demonstrated sterile neutrophilic inflammation, consistent with PG. Dermatology initiated systemic corticosteroids, mycophenolate mofetil and infliximab, resulting in partial disease control. This case highlights a unique presentation of simultaneous visceral and cutaneous PG in the absence of prior trauma or surgery and underscores the importance of considering non-infectious neutrophilic dermatoses in patients with refractory prostatitis and evolving systemic inflammation.