Pyoderma Gangrenosum in Two Successive Pregnancies Complicating Caesarean Wound

Sapna Vinit Amin,Ashwini Pai,Shripad Hebbar,Neha Bajapai,Sunanda Bharatnur

doi:10.1155/2014/654843

Sapna Vinit Amin, Ashwini Pai + Show 3 more

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https://doi.org/10.1155/2014/654843

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Abstract

Pyoderma gangrenosum (PG) is a rare ulcerative cutaneous disorder with tendency to recur in the injured area. Though most of the time is associated with chronic systemic conditions, it can occur in isolation and can be a diagnostic dilemma. The aetiology is poorly understood. The diagnosis is based on clinical features and excluding other causes of skin ulcers, as it does not have characteristic histopathology or laboratory findings. Lesions can develop after surgery, after trauma or de novo. We are reporting a 32-year-old pregnant lady with two previous instances of pyoderma gangrenosum in the previous pregnancy, who in postoperative period following caesarean section developed the same condition for the third time. She responded well to local wound care, oral Prednisolone, and Dapsone and made a good recovery. Pregnancy being an immunologically altered status can play a role in development of pyoderma gangrenosum and one should always rule out its possibility when there is a delayed wound healing.

Highlights

Brunsting et al in 1930 described clinical features of a rare cutaneous ulcerative condition in 5 cases occurring in adults [1]. They initially thought that lesions were produced by Streptococcus species and named the condition pyoderma gangrenosum, a purulent infection of cutis produced by pyogenic bacterial species
A 32-year-old 2nd gravida with previous lower segment caesarean section (LSCS) and history of pyoderma gangrenosum during her first pregnancy presented to university hospital at 32 weeks of gestation with threatened preterm labour
The classical presentation is the development of an erythematous papule or pustule that breaks down to form an ulcer with purulent discharge, as well as violaceous colored borders spreading peripherally and overhanging the ulcer bed

Summary

Introduction

Brunsting et al in 1930 described clinical features of a rare cutaneous ulcerative condition in 5 cases occurring in adults [1]. They initially thought that lesions were produced by Streptococcus species and named the condition pyoderma gangrenosum, a purulent infection of cutis produced by pyogenic bacterial species. Pregnancy being a state of immunosuppression may be affected in susceptible individuals. The diagnosis is made by excluding other causes of similar appearing cutaneous ulcerations, including infection, malignancy, vasculitis, collagen vascular diseases, diabetes, and trauma [4]. The prognosis of pyoderma gangrenosum is generally good; recurrences may occur and residual scarring is common. Therapy of pyoderma gangrenosum involves the multidisciplinary approach and use of antiinflammatory and immunosuppressive agents

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Summary