Objectives
Background: Pyoderma Gangrenosum is a rare neutrophilic dermatosis condition with an incidence of 3 to 10 per million people per year. Pyoderma Grangrenosum can be characterized by the abrupt appearance of painful, edematous, and erythematous lesions on the skin. Fever, leukocytosis and pathergy frequently accompany the cutaneous lesions. It is a diagnosis of exclusion and can frequently mimic necrotizing fasciitis, cutaneous infection, and sepsis and in this case Sweet Syndrome. The classical ulcerative form is more common in women with lower extremities and trunk and is characterized by the appearance of an inflammatory skin lesion that subsequently expands and breaks down to form an erosion or ulcer.
Methods
Case: A 43 year-old gravida 5 para 0323 woman was readmitted to this hospital for accepted wound cellulitis 1 week status post a primary low transverse cesarean section at 27 weeks and 5 days for acute on chronic vaginal bleeding complicating her pregnancy. She was started on broad spectrum antibiotics and underwent 3 wound debridements excising a large portion of her abdominal wall. In spite of aggressive treatment she continued to spike fevers and clinically was not improving. Throughout her hospitalization, a multidisciplinary team was coalesced to find a diagnosis. This was a challenging task in the setting that Pyoderma Gangrenosum is a diagnosis of exclusion. Her pathology was aseptic and therefore she was started on systemic steroids and quickly showed clinical improvement which helped support the diagnosis. She was discharged home 22 days after admission along with her infant.
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