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Pyoderma gangrenosum (PG) is a rare inflammatory cutaneous disease. Much of the underlying pathophysiology and etiology remain poorly understood, but PG is often associated with autoimmunity and chronic inflammatory and/or neoplastic diseases.1, 2 The disease can be extremely variable in presentation with either single or multiple lesions presenting on various parts of the body. PG is often difficult to diagnose because of variability of presentation, nonspecific laboratory findings, and indeterminate histology.3 Other conditions associated with cutaneous ulcerations must be considered in the differential diagnosis, such as infections, vasculitis, and malignancies. No official protocol exists for treatment of PG, but therapy usually involves immunosuppression in conjunction with wound care.1, 2, 4 We present a case of recalcitrant PG with widespread involvement that resolved with rituximab.