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April 1985

Progressive Cutaneous Herpes Simplex or Postoperative Progressive Gangrene

Author Affiliations

Department of Dermatology Hôpital Henri Mondor 94010 Creteil France

Arch Dermatol. 1985;121(4):449-450. doi:10.1001/archderm.1985.01660040023003

To the Editor.—  In the July 1984 issue, Shalev et al1 described a rapidly spreading superficial ulceration following surgery for acute appendicitis in a patient with acute myeloblastic leukemia.The clinical aspect of the lesion as shown in Fig 3 suggests postoperative progressive gangrene (PPG). It closely resembles the illustrations in the article by Hutchinson et al2 on PPG. A rare condition, PPG is also known as Meleney's synergistic gangrene, which is characterized by a superficial spreading ulceration following an operation. The disorder usually involves the chest or the abdominal wall and begins on the surgical scar, as in the patient described by Shalev et al. It is associated with fever. If the disease is not controlled, deterioration of the patient's general status may lead to death.The cause and treatment are matter for debate. Hutchinson et al,2 assuming that microaerophilic streptococci were responsible for the PPG,

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