An extensive pyoderma gangrenosum mimicking necrotizing fasciitis: An unusual case report

Abstract

Introduction Pyoderma Gangrenosum (PG) is a rare, benign and inflammatory disease characterized by ulcerative skin lesions. We report the successful management of an unusual case of PG following a caesarean section, with extensive cutaneous skin involvement and mimicking necrotizing fasciitis. Presentation of case A 36-year-old woman was admitted with extensive surgical site inflammation after a caesarean section. Despite antibiotic treatment and wound care, the clinical course deteriorated rapidly. Wound debridement following negative pressure closure was performed due to an immediate increase in skin necrosis. A diagnosis of PG was reached based on the absence of a positive wound culture, resistance to wound debridement and the histopathological results. A course of high-dose corticosteroids was started, and a successful clinical course was finally achieved. The patient is now in the 14th month of remission, with no recurrence. Discussion PG is often reported after bowel surgery, especially after complicated stoma or diverticulitis, breast surgery and occasionally after C-sections. The diagnosis of pyoderma gangrenosum may be challenging because of a wide variety of macroscopic features and its pronounced similarity to necrotizing fasciitis. Treatment with systemic corticosteroids is the most common management option, while surgical treatment is extremely controversial. Conclusion An extensive PG following surgery can mimic necrotizing fasciitis. An interdisciplinary treatment approach provides early diagnosis and effective treatment resulting in less morbidity.

Delayed diagnosis and management of necrotizing fasciitis of the left lower leg: A case report

“…NF can occur at any age, but it is particularly common in elderly men and very rare in children. [5,8] It tends to affect the limbs, trunk, perineum, and other body parts [9][10][11][12] (Table 1).…”

“…NF can occur at any age, but it is particularly common in elderly men and very rare in children. [5,8] It tends to affect the limbs, trunk, perineum, and other body parts [9–12] (Table 1). The risk factors of NF include old age, smoking, alcohol use, obesity, diabetes, peripheral vascular disease, liver disease, tumors, and prolonged high-dose steroid use, of which diabetes is the most common risk factor.…”

“…Aziret et al [11] 36, female No C-section Abdomen Chills, fever, surgical site infection, and acute abdomen Not reported Surgical debridement, antibiotic use (ceftriaxone, metronidazole, meropenem,and teicoplaninum), high-dose systemic corticosteroids…”

A Case Report of Extensive Pyoderma Gangrenosum on the Upper Third of the Body

“…2,9 The incidence is estimated at around 3-10 cases per million population per year. 5,6 Initial PG lesions can be in the form 1646 painful pustules, nodules, or plaques. 1,2 Within a few days, the skin lesions may enlarge and rupture to form well-defined ulcers, with irregular violaceous edges.…”

“…4,5 The lower extremity is the most common predilection site for PG. 1,6 However, it can also occur on other sites of the body, including the trunk, upper extremities, head, and neck. 7 Oral corticosteroids alone or in combination with other sparing agents such as azathioprine, cyclosporine, cyclophosphamide, mycophenolate mofetil, methotrexate, thalidomide, and dapsone were shown to be effective in most cases of PG.…”