Post-caesarean pyoderma gangrenosum mimicking surgical site infection: a diagnostic pitfall in the postpartum period

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that may occur after surgery and mimic wound infection. We report the case of a 30-year-old woman who developed painful progressive ulceration 7 days after caesarean section. Initial treatment with broad-spectrum antibiotics for presumed surgical site infection was ineffective. Clinical examination showed a large hypogastric ulcer with an erythematous base and undermined inflammatory borders. Histopathological examination of a biopsy taken from the ulcer edge demonstrated a dense dermal neutrophilic infiltrate, supporting the diagnosis of PG. Oral prednisolone at 1 mg/kg/day was started, with progressive improvement and complete re-epithelialization after 4 months. This case highlights the importance of considering PG in postoperative wounds that worsen despite adequate antimicrobial treatment, in order to avoid unnecessary surgical procedures and initiate timely immunosuppressive therapy.