Case Presentation: We describe a middle-aged female with past medical history of ulcerative colitis presenting to the emergency department with bilateral painful ulcers rapidly growing on her lower legs in the prior four weeks. She was consulted by a dermatologist and after a thorough clinical and pathology assessment (as a diagnosis of exclusion), treatment for pyoderma gangrenosum was started. Discussion: Pyoderma gangrenosum is a painful, chronic, ulcerative disorder often occurring in association with systemic disease. We review the clinical presentation of pyoderma gangrenosum and its complications. We describe the characteristics of ulcers with pictures from the patient. Our case illustrates the findings of pyoderma gangrenosum both clinically and pathologically.