Pyoderma gangrenosum induced by episiotomy

• Published in: BMJ case reports Vol. 2016; p. bcr2015213574
• Main Authors: Alani, Angela, Sadlier, Muriel, Ramsay, Bart, Ahmad, Kashif
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 19.01.2016; BMJ Publishing Group
• Series: Case Report
• Subjects: Adult; Anti-Infective Agents - administration & dosage; Anti-Ulcer Agents - administration & dosage; Arthritis; Bacterial infections; Case reports; Clobetasol - administration & dosage; Dapsone - administration & dosage; Dermatology; Diagnosis, Differential; Episiotomy - adverse effects; Europe (West); Female; Glucocorticoids - administration & dosage; Hematology; Hepatitis; Herpes viruses; Humans; Immunoglobulins; Infections; Inflammatory bowel disease; Liver diseases; New Disease; Omeprazole - administration & dosage; Omeprazole - therapeutic use; Pain; Patients; Prednisolone - administration & dosage; Pyoderma Gangrenosum - drug therapy; Pyoderma Gangrenosum - etiology; Pyoderma Gangrenosum - pathology; Skin diseases; Surgery; Treatment Outcome; White; Wound Healing
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2015-213574

We present a patient who developed genital ulceration within hours following episiotomy procedure during a normal vaginal delivery. This was initially treated by the gynaecology and medical team as cellulitis with no improvement. A diagnosis of pyoderma gangrenosum (PG) was made by the dermatology team 12 days later. On further investigation, she was found to be hepatitis C positive. We report this case to highlight the phenomenon of pathergy and frequent misdiagnosis of PG by other medical teams. When a postsurgical wound is not healing despite relevant systemic treatment, the clinician should suspect PG as an early diagnosis and treatment is crucial.