Pyoderma gangrenosum following a routine caesarean section: Pseudo-infection in a caesarean wound

Abstract

A 22-year-old booked primigravida underwent lower segment caesarean section for breech presentation. She developed signs and symptoms of wound infection by the fourth postoperative day. This was initially managed with antibiotics and wound dressing, but debridement was later undertaken after consulting surgeons. This resulted in an alarming worsening of the wound with sudden and fast increase in its size along with systemic symptoms. Wound biopsy established the diagnosis of pyoderma gangrenosum. The patient's management included oral medication with prednisolone, cyclosporin and dapsone and wound care. There was a dramatic response to this treatment. The wound completely healed by the eighth postoperative month. The oral medications were tapered off slowly and stopped by that time.

Pyoderma gangrenosum and pregnancy: an example of abnormal inflammation and challenging treatment

“…Eighteen reports (including the present one) include histological findings; all described neutrophilic infiltrate . Necrosis was also noted in six of the biopsies, while two biopsies showed signs of vasculitis .…”

“…Adjuvant therapy was added in 13 of these cases, two of them just being a topical intralesional corticosteroid and tacrolimus . The systemic agent most commonly used as adjuvant therapy was ciclosporin . This is most likely due to its rapid onset of action.…”

“…Thirteen reports also documented PG lesions occurring in locations that are often associated with trauma and bruising, such as the arms, legs and feet . Notably, two of these patients also developed PG lesions at the site of caesarean sections as described above …”

“…Pathergy may have been involved in the development of PG in several of the reviewed clinical cases. Eleven reports described women aged 24–43 years who developed PG at the site of caesarean incision 1 day to 4 weeks after delivery …”

“…Interestingly, nine patients were noted to have had prior episodes of PG 28,31,[41][42][43][44][45] or wound dehiscence. 30,46 Pathergy as a trigger of pyoderma gangrenosum in pregnancy Pathergy may have been involved in the development of PG in several of the reviewed clinical cases.…”