Carotid Pseudoaneurysm Repair in a Patient with Myeloproliferative Disorder Complicated by Contralateral Stroke, Graft Thrombosis, Pyoderma Gangrenosum, and Superinfection: A Case Report

Carotid pseudoaneurysms are rare and potentially life-threatening, often necessitating urgent surgical intervention. Patients with myeloproliferative disorders (MPD) are predisposed to thrombotic and inflammatory complications. Pyoderma gangrenosum (PG), a rare neutrophilic dermatosis, is often misdiagnosed in postoperative settings. In the following article, we present a case of a 58-year-old woman with Philadelphia-negative MPD, neutrophilic leukocytosis, thrombocytosis, osteoporosis, and hypothyroidism, who presented with a giant left common carotid artery pseudoaneurysm. She underwent urgent surgical revascularization via bypass using an autologous reversed saphenous vein graft from the right thigh and external carotid artery ligation. Immediately postoperatively, the patient developed left hemiparesis. Initial CT scans showed bypass graft occlusion and right MCA stroke. Immediate thrombolysis resulted in complete motor recovery, although the bypass remained occluded. On postoperative day 10, necrotic wound lesions developed, initially treated as infectious. After worsening post-debridement, dermatologic evaluation raised suspicion for PG, confirmed by biopsy. She responded well to corticosteroid therapy. Four weeks later, the thigh wound became superinfected with Pseudomonas aeruginosa and Klebsiella pneumoniae, successfully treated with broad-spectrum antibiotics. The patient fully recovered within two months. This case illustrates the complex interplay between vascular, thrombotic, and inflammatory complications in patients with MPD and emphasizes the importance of multidisciplinary care and early recognition of PG.