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Pediatric Cullen gangrene: Case report of postoperative pyoderma gangrenosum in a preterm infant with a complex
Sonja Diez1, Julia Syed1, Hanna Müller2
1Pediatric Surgery, Surgery Department, University Hospital Erlangen, Loschgestrasse 15, Erlangen, Germany.
Insights
This case report details Cullen gangrene, a rare postoperative pyoderma gangrenosum, in a premature infant with complex gastrointestinal issues. Early interdisciplinary diagnosis and treatment with steroids and immunoglobulins led to rapid recovery.
Area of Science:
- Pediatric Surgery
- Dermatology
- Neonatology
Background:
- Pyoderma gangrenosum (PG) is a rare ulcerative condition in pediatric patients.
- Cullen gangrene is the postoperative variant of PG, with limited pediatric case reports.
- Infantile PG, particularly the postoperative variant, presents diagnostic challenges.
Introduction:
Pyoderma gangrenosum (PG) is a rare condition in infants, children and adolescents. The postoperative variant of this rapidly progressive ulceration is known as Cullen gangrene. Only a few case reports of pediatric Cullen gangrene have been published.
Presentation Of Case:
We present a male infant (gestational age 31 + 6 weeks) with gastroschisis and intrauterine volvulus. After multiple operations due to his complex gastrointestinal malformation, the patient showed classical symptoms of postoperative PG (PPG) 4 weeks after birth. Diagnosis could be made early in an interdisciplinary approach, differentiating intraabdominal infection (vancomycin resistant enterococcus (VRE), candida albicans) from epifascial occurrence. Treatment with high-dose steroids and immunoglobulins was initiated immediately and led to rapid recovery.
Discussion:
The unusual combination of a complex gastrointestinal malformation and an intraabdominal infection with VRE and candida albicans made the diagnosis difficult. However, early diagnosis is crucial in the treatment of Cullen gangrene.
Conclusion:
This is the first case report of Cullen gangrene presenting in an infant (at 4 weeks of age).