A woman in her 70s with a history of rectal cancer and colostomy presented with peristomal ulcerations covered by superficial green-brown eschar (Figure 1). A biopsy 2 months prior revealed ulceration with underlying mixed inflammation with neutrophils. Following negative cultures, she was treated for presumptive pyoderma gangrenosum with topical and systemic corticosteroids. However, she did not improve, and subsequent bacterial cultures identified Pseudomonas aeruginosa and Enterobacter cloacae complex, leading to the diagnosis of peristomal ecthyma gangrenosum.

Lipomatous hypertrophy of the atrial septum is a benign cardiac tumor predominantly found in adults. The condition occurs in 1% to 8% of the population and is more common in those with increased visceral adiposity.1

A woman in her 70s with a history of rectal cancer and colostomy presented with peristomal ulcerations covered by superficial green-brown eschar (Figure 1). A biopsy 2 months prior revealed ulceration with underlying mixed inflammation with neutrophils. Following negative cultures, she was treated for presumptive pyoderma gangrenosum with topical and systemic corticosteroids. However, she did not improve, and subsequent bacterial cultures identified Pseudomonas aeruginosa and Enterobacter cloacae complex, leading to the diagnosis of peristomal ecthyma gangrenosum.