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Pseudo-wound infection after a caesarean section: Case report of unrecognized Pyoderma Gangrenosum
Carlina E van Donkelaar1, Johanna M H de Haan2, Johan F M Lange2
1Department of Obstetrics and Gynecology, Ziekenhuisgroep Twente, Almelo, the Netherlands.
Background:
Pyoderma Gangrenosum (PG) is a rare auto-inflammatory disease, characterized by painful ulcerative skin-lesions often developing at sites of injury or surgery because of the typical pathergy phenomena. We describe an unusual case of PG after a caesarean section with excessive extra-cutaneous manifestation within internal organs.
Presentation Of Case:
A 21-year-old Dutch primigravida developed signs of sepsis after a caesarean section. Despite antibiotic treatment, fast clinical deterioration occurred. Exploration of the wound showed necrosis of the uterus and surrounding tissues. Due to the progression of necrosis, consecutive debridement procedures were executed resulting in a substantial abdominal wall defect. The progressive clinical course of the necrosis combined with absence of positive wound cultures and histology of prominent interstitial neutrophilic infiltration, led to the diagnosis 'Pyoderma Gangrenosum'. Treatment with high dose corticosteroids led to rapid regression of the disease. After several weeks, the abdominal wall defect was surgically corrected under systemic corticosteroid therapy.
Discussion:
This case of PG is unique due to the excessive extra-cutaneous presentation, which contributed to delayed diagnosis. Several surgical interventions in the active stage of disease resulted in expansion of PG and substantial morbidity for the patient.
Conclusion:
Post-operative PG can mimic infectious diseases, but treatment is substantially different. This case of extensive PG highlights the importance of timely recognition and treatment of the disease to reduce iatrogenic morbidity.
Insights
This case study details a rare instance of Pyoderma Gangrenosum (PG) following a caesarean section, presenting with severe internal organ involvement. Prompt diagnosis and corticosteroid treatment were crucial for managing this extensive post-operative skin condition.
Area of Science:
- Dermatology
- Auto-inflammatory Diseases
- Surgical Complications
Background:
- Pyoderma Gangrenosum (PG) is a rare auto-inflammatory disorder.
- Characterized by ulcerative skin lesions, often triggered by trauma (pathergy).
- This case involves unusual extensive extra-cutaneous manifestations.
Observation:
- A 21-year-old patient developed sepsis post-caesarean section.
- Necrosis of uterine and surrounding tissues despite antibiotics.
- Diagnosis of PG was made due to clinical course and neutrophilic infiltration, not infection.
Findings:
- High-dose corticosteroids rapidly regressed the Pyoderma Gangrenosum.
- Surgical interventions during active disease worsened PG.
- Delayed diagnosis occurred due to atypical, extensive internal organ involvement.
Implications:
- Post-operative PG can mimic infections, necessitating distinct diagnostic and treatment approaches.
- Timely recognition of extensive PG is vital to prevent iatrogenic morbidity.
- Highlights the importance of considering PG in post-surgical sepsis with non-infectious ulcerative lesions.
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