Pyoderma gangrenosum at an episiotomy site in successive pregnancies: A case report

Pyoderma gangrenosum (PG) is an ulcerative, neutrophil-predominant inflammatory disease of the skin that commonly presents as painful ulcers. PG during pregnancy is extremely rare. We report the case of a 28-year-old woman with a painful, rapidly progressive ulcerative lesion at an episiotomy site presenting 16 days following a vaginal delivery. No systemic association was found after an exhaustive work-up and the patient was successfully managed with the help of oral prednisolone. It should be noted that when a postoperative ulcerative wound defect is not healing despite standard wound care, antibiotic treatment, and negative cultures, the possibility of PG should be considered. We conclude that early diagnosis of PG is essential because this condition is usually misdiagnosed and surgical intervention may lead to deterioration of lesions. The case highlights the uncommon presentation of PG at a rare site, thereby calling for a high index of suspicion in order to arrive at the diagnosis.