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

Area of Science:

• Dermatology
• Surgical Pathology
• Critical Care Medicine

Background:

• Postoperative pyoderma gangrenosum (PG) is a rare but severe complication following surgical procedures.
• It is often misdiagnosed as a necrotizing infection, leading to delayed or inappropriate treatment.
• Cesarean section is an uncommon precipitating event for PG.

Observation:

• A 28-year-old woman presented with vasopressor-dependent shock 5 days post-cesarean section, initially suspected to have a necrotizing infection.
• Despite multiple surgical debridements and negative cultures, her condition worsened, showing pathergic changes at biopsy sites.
• Histopathology revealed neutrophilic infiltrate and necrosis, consistent with PG, not infection.

Findings:

• The patient was diagnosed with postoperative pyoderma gangrenosum (PG) presenting as shock.
• Treatment with perioperative corticosteroids provided transient improvement.
• Successful wound closure was achieved 12 weeks post-CS using delayed primary closure (DPC) with immunosuppression (cyclosporine and prednisone) and incisional negative pressure wound therapy (iNPWT).

Implications:

• This case underscores the importance of considering PG in the differential diagnosis of postoperative wound complications, especially when infection is not evident.
• Early recognition and appropriate immunosuppressive therapy are crucial for managing postoperative PG.
• Incisional negative pressure wound therapy with a visualization window may be a valuable adjunct in managing complex PG wounds postoperatively.