Case report of two COVID-19 patients with sacral pressure injuries associated with pyoderma gangrenosum

With the continuous spread of the COVID-19 pandemic, an increasing number of patients have been admitted to the ICU with severe respiratory complications requing prolonged supine positioning. Recently, many case reports have been published regarding dermatological manifestations associated with the COVID-19 disease. Yet, there is little information about the clinical features. Pyoderma gangrenosum (PG) is an ulcerative noninfectious inflammatory disease of the skin. At least in 50% of the cases the etiology is unknown. Nevertheless, PG has been known to be associated with many systemic diseases. In this paper, the authors report a case series of two critically ill patients with COVID-19 who developed sacral ulcers during their recovery at the ICU. These ulcers had an atypical course showing an exacerbation after surgical debridements. Thus, PG was suspected and confirmed by the clinical evolution and biopsies taken from the wounds. To the best of the authors' knowledge, no previous papers have reported sacral pressure injuries associated with pyoderma gangrenosum in patients with COVID-19. PG should be suspected in those with COVID-19 who developed nonhealing pressure injuries.