Pyoderma Gangrenosum Precipitated by Breast Engorgement Following Lactation Discontinuation: A Rare Case Report

Abstract

Pyoderma gangrenosum (PG) is an inflammatory disease characterized by recurrent painful ulcers, eventually leading to cribriform scars. PG is mostly a diagnosis of exclusion with neutrophilic skin infiltration. We present a case of a 35-year-old female patient whose first presentation of PG occurred in the first trimester of pregnancy, which recurred after discontinuation of breastfeeding. The patient also had a history of taking prolonged IM and IV analgesics for her chronic migraines. The patient was initially treated with steroids and necessary wound care, during which symptoms remained controlled. However, a year later, the patient presented with an acute flare-up of the disease in her postpartum period, mainly involving her breasts bilaterally. Extensive wound debridement was performed due to the severity of her necrotic ulcers and failure to respond to conservative management, which was followed by partial thickness skin grafting.

Pyoderma Gangrenosum, a Challenging Postpartum Diagnosis—Case Report and Literature Review

“…Originating from the initial description by Brunsting et al in 1930, this dermatosis predominantly afflicts females, typically within the age range of 20 to 50 years [1,2,[4][5][6]. The typical anatomical targets of PG encompass the lower limbs, hands, feet, and trunk, with the occasional involvement of diverse sites such as the genital mucosa, eyes, spleen, and lungs [1,7]. Distinct clinical variants of PG include the classic ulcerative type and another three forms (vegetative, bullous-pustular, and superficial granulomatous) [1,7].…”

“…Pyoderma gangrenosum (PG) represents a rare and intricate noninfectious inflammatory neutrophilic dermatosis, associated with substantial morbidity [1][2][3]. Originating from the initial description by Brunsting et al in 1930, this dermatosis predominantly afflicts females, typically within the age range of 20 to 50 years [1,2,[4][5][6].…”

“…Pyoderma gangrenosum (PG) represents a rare and intricate noninfectious inflammatory neutrophilic dermatosis, associated with substantial morbidity [1][2][3]. Originating from the initial description by Brunsting et al in 1930, this dermatosis predominantly afflicts females, typically within the age range of 20 to 50 years [1,2,[4][5][6]. The typical anatomical targets of PG encompass the lower limbs, hands, feet, and trunk, with the occasional involvement of diverse sites such as the genital mucosa, eyes, spleen, and lungs [1,7].…”

“…The typical anatomical targets of PG encompass the lower limbs, hands, feet, and trunk, with the occasional involvement of diverse sites such as the genital mucosa, eyes, spleen, and lungs [1,7]. Distinct clinical variants of PG include the classic ulcerative type and another three forms (vegetative, bullous-pustular, and superficial granulomatous) [1,7]. The bullous subtype is frequently associated with hematologic disorders such as myelodysplastic syndrome [3,8,9].…”

“…The aberrant immune response in afflicted individuals typically commences with the formation of an erythematous papule, pustule, or vesicle, progressing swiftly to the development of chronic, recurrent, and painful necrotic ulcers surrounded by a violaceous hue [1,10,12,13]. Early lesions show neutrophilic folliculitis/perfolliculitis with dermal abscess.…”