Pyoderma Gangrenosum Following Cesarean Section: A Case Report With Individualized Management

Area of Science:

• Dermatology
• Immunology
• Obstetrics & Gynecology

Background:

• Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis causing necrotizing skin ulcers.
• PG following cesarean section (CS) is exceptionally rare and often mistaken for surgical site infections, leading to delayed or incorrect treatment.

Purpose of the Study:

• To report a rare case of severe pyoderma gangrenosum following cesarean section.
• To highlight the diagnostic challenges and effective management strategies for post-cesarean PG.

Main Methods:

• A 24-year-old woman developed rapidly progressing ulcers post-CS, initially treated as infection.
• Diagnosis of PG was confirmed via clinical presentation, sterile cultures, and histopathology.
• Treatment involved triple immunosuppressive therapy: methylprednisolone, cyclosporine, and etanercept.

Main Results:

• The patient experienced rapid disease progression and pathergy after debridement.
• Triple immunosuppressive therapy led to rapid disease control and complete epithelialization within four months.
• No recurrence or adverse drug reactions were observed during follow-up.

Conclusions:

• Post-cesarean PG requires high clinical suspicion to differentiate from infections.
• Early and aggressive triple immunosuppressive therapy is an effective strategy for severe cases, enabling corticosteroid dose reduction.
• This approach achieved sustained remission in a severe case of post-cesarean PG.