Pyoderma gangrenosum following an unplanned caesarean section: a patient revisited

• Published in: BMJ case reports Vol. 14; no. 2; p. e238702
• Main Authors: Ghumra, Waseem, Gold, Adam, Azurdia, Richard Michael
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 22.02.2021; BMJ Publishing Group
• Subjects: Abdomen; Adrenal Cortex Hormones; Adult; Age; Biopsy; Case Report; Case reports; Cesarean section; Cesarean Section - adverse effects; Cytokines; Debridement; Dermatology; Female; Humans; Infections; Negative-Pressure Wound Therapy; Patients; Placental abruption; Pregnancy; Pyoderma Gangrenosum - drug therapy; Pyoderma Gangrenosum - etiology; Skin diseases; Skin Transplantation; Steroids; Ulcers; Vagina; Wound healing; obstetrics and gynaecology; wound care; dermatology
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-238702

A 35-year-old woman was referred urgently to the dermatology department because of significant wound breakdown 3 weeks following an emergency caesarean section. Examination revealed a full thickness, undermined ulcer spanning the width of the patient’s caesarean scar, exposing the patient’s uterus. Clinical appearances were consistent with pyoderma gangrenosum. The patient has a history of complicated pyoderma gangrenosum, having undergone skin grafts 14 years prior, for ulcers on her lower legs. That episode was the subject of a case report, published in the BMJ, in 2007. On this occasion, the patient was treated with oral corticosteroids, and ciclosporin based on its efficacy during her previous episode, which in conjunction with negative pressure wound therapy, resulted in complete re-epithelialisation of her ulcer within 6 months.