Suzuki Nanao, Murata Tsuyoshi, Fukuda Toma, Kanno Aya, Kyozuka Hyo, Yasuda Shun, Yamaguchi Akiko, Fujimori Keiya
Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan.
Case Rep Womens Health. 2020 Sep 1;28:e00253. doi: 10.1016/j.crwh.2020.e00253. eCollection 2020 Oct.
Pyoderma gangrenosum and myelodysplastic syndrome in pregnant women are both very rare, but can coexist. Here, we present a case of pyoderma gangrenosum in a cesarean section wound in a woman with myelodysplastic syndrome.
A 34-year-old woman presented with thrombocytopenia and macrocytic anemia during pregnancy. The pregnancy was uneventful until 36 weeks of gestation, when premature rupture of membranes occurred and a cesarean section was performed for breech presentation. She presented four days later with redness and blisters at the wound site. Surgical site infection was diagnosed but did not improve with antibiotics, and multiple wound cultures were negative. Skin biopsy indicated pyoderma gangrenosum, and the redness and blisters responded to oral prednisolone. Post-partum bone marrow aspiration showed myelodysplastic syndrome. As the patient demonstrated no symptoms such as abnormal bleeding, no additional treatment was started, and she went on to receive regular follow-up for myelodysplastic disorder.
This case shows the need for further assessment of hematological disorders diagnosed in pregnancy in women with pyoderma gangrenosum post-partum.
孕妇坏疽性脓皮病和骨髓增生异常综合征都非常罕见，但可能同时存在。在此，我们报告一例患有骨髓增生异常综合征的女性剖宫产伤口出现坏疽性脓皮病的病例。
一名34岁女性在孕期出现血小板减少和大细胞性贫血。妊娠至36周前一切顺利，此时胎膜早破，因臀位行剖宫产。术后四天，她伤口部位出现发红和水疱。诊断为手术部位感染，但使用抗生素后未改善，多次伤口培养结果均为阴性。皮肤活检显示为坏疽性脓皮病，口服泼尼松龙后发红和水疱症状得到缓解。产后骨髓穿刺显示骨髓增生异常综合征。由于患者未表现出异常出血等症状，未开始额外治疗，她继续接受骨髓增生异常疾病的定期随访。
该病例表明，对于产后患有坏疽性脓皮病的女性孕期诊断的血液系统疾病，需要进一步评估。
