Abstract
BackgroundPyoderma gangrenosum is a rare ulcerative skin disease. The diagnosis is based on clinical features and excluding other causes of skin ulcers, as it does not have characteristic histopathology or laboratory findings. The etiology is poorly understood. Lesions can develop spontaneously, after surgery or after trauma.Case presentationWe present the case of a 32-year-old woman with ulcerative wound defect after caesarean section. The wound was not healing despite standard wound care and antibiotic treatment. Pyoderma gangrenosum was diagnosed and after high dose corticosteroids wound healing started.ConclusionEarly diagnosis and subsequent treatment of pyoderma gangrenosum are crucial for limiting scar tissue. Diagnosis of pyoderma gangrenosum could easily be missed since gynaecologists are rarely confronted with this disorder.
Highlights
Pyoderma gangrenosum is a rare ulcerative skin disease
Early diagnosis and subsequent treatment of pyoderma gangrenosum are crucial for limiting scar tissue
Diagnosis of pyoderma gangrenosum could be missed since gynaecologists are rarely confronted with this disorder
Summary
Pyoderma gangrenosum is a rare skin disease. Classical clinical presentation is a first development of an erythematous papule or pustule, secondary forming a rapidly progressing, painful cutaneous ulcer with characteristic violaceous colored borders. We present a woman with pyoderma gangrenosum after caesarean section. A 32 year old woman was regularly seen at our antenatal outpatient clinic during her first pregnancy (gravida 1 para 0) Her medical history revealed cervical intraepithelial neoplasia (CIN II), which was treated 2 years earlier by loop excision and a bilateral breast reduction with complicated but spontaneous wound healing 13 years earlier. On day 8 postpartum the woman had still a spiking fever and a raised CRP despite amoxicillin clavunalate. On day 11 postpartum a wound culture was indicative for staphylococcus aureus and flucloxacillin was started. Twenty-three days after caesarean section, the woman was readmitted because of severe wound pain. Because the wound defect did not stabilise, prednisone was increased to 100 mg/day orally. The woman's family history showed familial polyposis but colonoscopy indicated no abnormality
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