{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T09:43:43Z","timestamp":1775555023611,"version":"3.50.1"},"reference-count":27,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/jcm15072768","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T08:09:00Z","timestamp":1775549340000},"page":"2768","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Carotid Pseudoaneurysm Repair in a Patient with Myeloproliferative Disorder Complicated by Contralateral Stroke, Graft Thrombosis, Pyoderma Gangrenosum, and Superinfection: A Case Report"],"prefix":"10.3390","volume":"15","author":[{"given":"Cristian","family":"Voica","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan Alexandru","family":"Cercel","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Sabina","family":"Safta","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bogdan","family":"Popescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iulian","family":"Tiboaca","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Dumitru","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5340-8929","authenticated-orcid":false,"given":"Gabriel-Petre","family":"Gorecki","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Faculty of Medicine, Titu Maiorescu University, 040051 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0056-0740","authenticated-orcid":false,"given":"Bogdan Severus","family":"Gaspar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of General Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anca Mihaela","family":"C\u00eertog","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2241-279X","authenticated-orcid":false,"given":"Horatiu","family":"Moldovan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania"},{"name":"Academy of Romanian Scientists, 54, Spl. Independentei, 050711 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.ejvs.2015.05.002","article-title":"Management of extracranial carotid artery aneurysm","volume":"50","author":"Welleweerd","year":"2015","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1001\/jamaoncol.2015.89","article-title":"Myeloproliferative Neoplasms: A Contemporary Review","volume":"1","author":"Tefferi","year":"2015","journal-title":"JAMA Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1960","DOI":"10.1161\/ATVBAHA.124.321008","article-title":"Decoding Endothelial MPL and JAK2V617F Mutation: Insight into Cardiovascular Dysfunction in Myeloproliferative Neoplasms","volume":"44","author":"Zhang","year":"2024","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1038\/s41408-024-01169-6","article-title":"Thrombosis in myeloproliferative neoplasms: A viewpoint on its impact on myelofibrosis, mortality, and solid tumors","volume":"14","author":"Barbui","year":"2024","journal-title":"Blood Cancer J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1182\/blood.2019002614","article-title":"Arterial thrombosis in philadelphia-negative myeloproliferative neoplasms predicts second cancer: A case-control study","volume":"135","author":"Ghirardi","year":"2020","journal-title":"Blood"},{"key":"ref_6","first-page":"246","article-title":"Secondary Solid Cancers in Patients with Philadelphia Chromosome-Negative Myeloproliferative Neoplasms: A Multicenter Study","volume":"41","author":"Hindilerden","year":"2024","journal-title":"Turk. J. Haematol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1177\/0218492312438562","article-title":"Cardiac surgery in cases of myeloproliferative neoplasm: Risk factor for stroke","volume":"20","author":"Sommer","year":"2012","journal-title":"Asian Cardiovasc. Thorac. Ann."},{"key":"ref_8","first-page":"491","article-title":"Surgical Complications in Myeloproliferative Neoplasm Patient with Essential Thrombocythemia: A Case Report","volume":"15","author":"Rinaldi","year":"2022","journal-title":"Int. Med. Case Rep. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/1477-7819-6-31","article-title":"Pyoderma gangrenosum after central venous device insertion in a patient with myelofibrosis: A case report","volume":"6","author":"Inan","year":"2008","journal-title":"World J. Surg. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1136\/bmj.333.7560.181","article-title":"Diagnosis and treatment of pyoderma gangrenosum","volume":"333","author":"Brooklyn","year":"2006","journal-title":"BMJ"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1111\/j.1468-3083.2009.03199.x","article-title":"Pyoderma gangrenosum: An updated review","volume":"23","author":"Ruocco","year":"2009","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_12","first-page":"646","article-title":"Postoperative pyoderma gangrenosum: A clinical review","volume":"73","author":"Tolkachjov","year":"2015","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/01.ASW.0000661796.90753.f3","article-title":"Pyoderma Gangrenosum and Superimposed Infection: A Case Report","volume":"33","author":"Gavioli","year":"2020","journal-title":"Adv. Skin Wound Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.jvs.2014.07.092","article-title":"Surgical and medical management of extracranial carotid artery aneurysms","volume":"61","author":"Fankhauser","year":"2015","journal-title":"J. Vasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S173","DOI":"10.1148\/rg.25si055503","article-title":"Pseudoaneurysms and the role of minimally invasive techniques in their management","volume":"25","author":"Saad","year":"2005","journal-title":"Radiographics"},{"key":"ref_16","first-page":"339","article-title":"Extracranial carotid artery aneurysms","volume":"38","author":"Pulli","year":"1997","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1007\/s00270-005-0367-7","article-title":"Covered stent-graft treatment of traumatic internal carotid artery pseudoaneurysms: A review","volume":"29","author":"Maras","year":"2006","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.ejvs.2016.12.026","article-title":"Cranial Nerve Injury After Carotid Endarterectomy: Incidence, Risk Factors, and Time Trends","volume":"53","author":"Kakisis","year":"2017","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/S0741-5214(03)00418-X","article-title":"Early and late outcome after carotid artery bypass grafting with saphenous vein","volume":"38","author":"Lauder","year":"2003","journal-title":"J. Vasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"372","DOI":"10.3324\/haematol.12053","article-title":"GIMEMA CMD-Working Party. Recurrent thrombosis in patients with polycythemia vera and essential thrombocythemia: Incidence, risk factors, and effect of treatments","volume":"93","author":"Za","year":"2008","journal-title":"Haematologica"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.mayocp.2018.08.022","article-title":"3023 Mayo Clinic Patients with Myeloproliferative Neoplasms: Risk-Stratified Comparison of Survival and Outcomes Data Among Disease Subgroups","volume":"94","author":"Szuber","year":"2019","journal-title":"Mayo Clin. Proc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1056\/NEJMoa043800","article-title":"United Kingdom Medical Research Council Primary Thrombocythemia 1 Study. Hydroxyurea compared with anagrelide in high-risk essential thrombocythemia","volume":"353","author":"Harrison","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.bjps.2014.12.036","article-title":"A systematic review of post-surgical pyoderma gangrenosum: Identification of risk factors and proposed management strategy","volume":"68","author":"Zuo","year":"2015","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1056\/NEJMoa013383","article-title":"Skin ulcers misdiagnosed as pyoderma gangrenosum","volume":"347","author":"Weenig","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.jaad.2004.10.006","article-title":"Treatment recommendations for pyoderma gangrenosum: An evidence-based review of the literature based on more than 350 patients","volume":"53","author":"Reichrath","year":"2005","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e253","DOI":"10.1111\/1346-8138.16845","article-title":"Clinical guidance of pyoderma gangrenosum 2022","volume":"50","author":"Yamamoto","year":"2023","journal-title":"J. Dermatol."},{"key":"ref_27","first-page":"e47688","article-title":"Late In-Stent Thrombosis After Carotid Artery Stenting for Symptomatic Internal Carotid Artery Stenosis in a Patient with JAK2 V617F-Positive Essential Thrombocythemia","volume":"15","author":"Arai","year":"2023","journal-title":"Cureus"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2768\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T08:44:01Z","timestamp":1775551441000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2768"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,6]]},"references-count":27,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15072768"],"URL":"https:\/\/doi.org\/10.3390\/jcm15072768","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,6]]}}}