Necrotizing fasciitis from perforated sigmoid diverticulitis with subsequent pyoderma gangrenosum: a case report
Bibliographic record
Abstract
Postsurgical pyoderma gangrenosum is a very rare form of cutaneous ulceration that is poorly recognized outside of dermatology and in some circumstances has been mistaken for necrotizing fasciitis. Here, we present a rare case of sigmoid diverticulitis with left ureter obstruction that perforated and quickly progressed into necrotizing fasciitis of the left buttock and leg via retroperitoneal spread in an immunocompetent patient. Nearly a year after intense surgical therapy, the patient rapidly developed ulcerating lesions over the left hip which presented a diagnostic dilemma. These were initially thought to represent Marjolin's ulcers, which would require aggressive local excision. Multiple diagnostic imaging tests and biopsies eventually confirmed pyoderma gangrenosum, which was successfully treated with immunosuppressive therapy. This case highlights the need for a very broad differential diagnosis and wide expertise consultation when managing unusual postsurgical complications, especially when treatment modality critically depends on the correct diagnosis.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".