Aziret Mehmet, Kara Şeyma, Yaldız Mahizer, Köse Nur, Aşıkuzunoğlu Feyza, Cevrioğlu Arif Serhan
Sakarya University Faculty of Medicine, Department of General Surgery Sakarya, Turkey.
Sakarya University Faculty of Medicine, Department of Obstetrics and Gynecology Sakarya, Turkey.
Int J Surg Case Rep. 2021 Apr;81:105697. doi: 10.1016/j.ijscr.2021.105697. Epub 2021 Feb 26.
Pyoderma Gangrenosum (PG) is a rare, benign and inflammatory disease characterized by ulcerative skin lesions. We report the successful management of an unusual case of PG following a caesarean section, with extensive cutaneous skin involvement and mimicking necrotizing fasciitis.
A 36-year-old woman was admitted with extensive surgical site inflammation after a caesarean section. Despite antibiotic treatment and wound care, the clinical course deteriorated rapidly. Wound debridement following negative pressure closure was performed due to an immediate increase in skin necrosis. A diagnosis of PG was reached based on the absence of a positive wound culture, resistance to wound debridement and the histopathological results. A course of high-dose corticosteroids was started, and a successful clinical course was finally achieved. The patient is now in the 14th month of remission, with no recurrence.
PG is often reported after bowel surgery, especially after complicated stoma or diverticulitis, breast surgery and occasionally after C-sections. The diagnosis of pyoderma gangrenosum may be challenging because of a wide variety of macroscopic features and its pronounced similarity to necrotizing fasciitis. Treatment with systemic corticosteroids is the most common management option, while surgical treatment is extremely controversial.
An extensive PG following surgery can mimic necrotizing fasciitis. An interdisciplinary treatment approach provides early diagnosis and effective treatment resulting in less morbidity.
坏疽性脓皮病（PG）是一种罕见的良性炎症性疾病，其特征为溃疡性皮肤病变。我们报告了一例剖宫产术后罕见的PG病例，该病例皮肤广泛受累，类似坏死性筋膜炎，最终成功治愈。
一名36岁女性剖宫产术后因手术部位广泛炎症入院。尽管进行了抗生素治疗和伤口护理，但临床病程迅速恶化。由于皮肤坏死立即增加，遂在负压封闭后进行伤口清创。基于伤口培养结果为阴性、伤口清创无效以及组织病理学结果，最终诊断为PG。开始使用大剂量皮质类固醇治疗，最终临床病程取得成功。患者目前处于缓解期第14个月，无复发。
PG常见于肠道手术后，尤其是复杂造口或憩室炎、乳腺手术后，偶尔也见于剖宫产术后。坏疽性脓皮病的诊断可能具有挑战性，因为其宏观特征多种多样，且与坏死性筋膜炎极为相似。全身皮质类固醇治疗是最常见的治疗选择，而手术治疗极具争议性。
术后广泛的PG可能类似坏死性筋膜炎。多学科治疗方法可实现早期诊断和有效治疗，从而降低发病率。
