Challenge of diagnosing pyoderma gangrenosum after caesarean section

Abstract

Pyoderma gangrenosum is a neutrophilic skin disease that leads to extensive, painful, necrotic ulcerations, particularly at surgical sites. As obstetric cases with pyoderma gangrenosum are rare and, therefore, often misdiagnosed initially, it is important to raise awareness about this rare complication. Here, we describe a patient who presented with pyoderma gangrenosum at the surgical site 4 days after undergoing a caesarean section. The erythema was initially misdiagnosed as wound infection, and the patient, who was experiencing pain, underwent antibiotic treatment and surgical wound debridement. When the wound was unresponsive to these treatments, a dermatologist was consulted who suspected pyoderma gangrenosum and began a high-dose corticosteroids therapy, which led to a fulminant improvement of the local wound. In conclusion, the rare diagnosis of pyoderma gangrenosum should be considered in the differential diagnosis of a suspected surgical wound infection. Early interdisciplinary treatment is essential to avoid further complications.

Pyoderma Gangrenosum, a Challenging Postpartum Diagnosis—Case Report and Literature Review

“…Roa and Futami et al presented cases of PG in patients who gave birth vaginally, while the means of birth were unspecified in Aoussar et al and Lyons et al [6,23,27,53]. Premature birth occurred in 13 cases due to various emergencies, such as chorioamnionitis, abruptio placenta, and vaginal bleeding [10,20,21,33,35,37,40,[42][43][44]47,48,51]. However, the method of delivery was unspecified in 16 cases [4][5][6]18,24,[27][28][29]31,36,38,39,45,46,49,52], with the remaining cases delivering at term.…”

“…However, the method of delivery was unspecified in 16 cases [4][5][6]18,24,[27][28][29]31,36,38,39,45,46,49,52], with the remaining cases delivering at term. Notably, 15 cases of postpartum C-section site PG were recurrent [15,24,25,27,30,[32][33][34][40][41][42][43]46,48,52], only 1 case exhibited the first episode of the disease linked to surgical intervention with subsequent relapses [23], and in the rest of the included cases, this was the first manifestation of the disease.…”

“…Other treatment approaches included systemic corticotherapy and local tacrolimus [10]; systemic corticotherapy and dapsone [33,39]; a combination of corticotherapy, cyclosporine, and dapsone in two cases [29,34]; and a combination of corticotherapy, cyclosporine, and dapsone in Alani et al's case with mycophenolate mofetil [38]. Several cases required complex therapies, such as corticotherapy and azathioprine followed by vacuum-assisted closure and splitthickness skin graft [15]; negative pressure wound therapy and high-dose corticosteroid therapy [43,46]; corticotherapy and human immunoglobulin therapy; wound debride-ment, vacuum sealing negative pressure drainage, skin grafting, and hyperbaric oxygen therapy [4]; intravenous immunoglobulin alone [45]; and corticotherapy combined with intravenous immunoglobulin [49] or cyclosporine with skin grafting [53].…”

The Histopathology of Leg Ulcers

“…The lower leg is the most commonly affected site. However, it can appear on the whole body; operation wounds are also predilected sites [100,101]. Diagnosis is challenging and often delayed, and misdiagnosis is frequent [52,102].…”

Post-Cesarean Section Pyoderma Gangrenosum Presenting with Vasopressor-dependent Shock: Long-term Follow-up after Delayed Primary Closure

“… 3 , 4 Misdiagnosis of PG as infection often leads to surgical debridement, which inevitably exacerbates symptoms of PG and further delays definitive diagnosis and treatment. 6 …”