Article Type : Case Report
Authors : Al Hasan J, Diab K, Kalach Z, Saliba M, Ghazal K
Keywords : Hemangioma; Giant hemangioma; Kasabach-merritt syndrome; Hepatectomy; ALPPS
A neutrophil-predominant inflammatory condition known as pyoderma gangrenosum (PG) manifests initially as a sterile pustule and may proceed to ulcerations. Although the underlying cause is unknown, systemic inflammatory diseases such as inflammatory bowel disease, arthritis, and hematological abnormalities are frequently linked to its manifestation. Contrarily, pregnant women experience progressive neutrophilia over the pregnancy, leadoff of the pregnancy, which leads to a significant inflammatory event that aids in the onset of labour. Even though it doesn't happen often, PG has been linked to pregnancy, which adds another link to systemic inflammation as an underlying cause of PG. We examined known case of PG in pregnant women and made assumptions about its causation based on their clinical manifestations. We also include the reported treatments and how well they like team worked for these patients.
In 1930, published the first description of Pyoderma gangrenosum (PG) . It is a rare chronic ulcerative illness whose cause is unknown. It is clinically distinguished by small beginning pustules that progress into characteristic ulcers with undermined edges and a violaceous tint. The majority of the time, PG is linked to haematological conditions like paraproteinemia and leukemias as well as systemic diseases like inflammatory bowel disorders, inflammatory polyarthritis, and inflammatory bowel diseases. [2,3]. The biopsy material lacks pathognomonic information, making the diagnosis more challenging and relying more on excluding other comparable illnesses exclusion of other illnesses that are comparable . We describe a case of PG in pregnancy due to the association's rarity as well as several peculiar presenting symptoms that made the diagnosis challenging. The value of participating in multidisciplinary teams.
When she was 31+5 weeks pregnant, a 29-year-old G3P1A1L1 woman who had previously undergone treatment for Hodgkin lymphoma during her previous pregnancy two years prior; presented with diffuse, painful, ulcerative skin lesions, erythematous pustules and papules over the legs and forearms, and an erythematous plaque rash on the cheeks. No history of weight loss and no related systemic symptoms. She has a history of caesarean deliveries and is not known to have any allergies to foods or medications. Other than multivitamins, she is not taking any drugs (iron and calcium). The patient reported that after being injured in the yard, she experienced first-trimester diffuse tender papules and a plaque rash on her arms, which quickly resolved on its own after two to three days. One month prior to admission, the lesions that started as vesicles and progressed to blisters, bullae, and pustules failed to go away despite treatment with antihistamines and topical corticosteroids. Instead, they became more painful ulcers and sores that were accompanied by itching, edema, and discharged purulent-like material (Figures 1,2).
Figure 1: Erythematous plaques on the cheeks.
On the cheeks, a butterfly-shaped erythematous plaque develops. On the right and left forearms, as well as the wrist, several urticarial lesions were discovered. She was restless upon admission, but her vital signs were normal. On physical examination, the uterus is in line with gestational age (31 cm), and auscultation reveals clear airways. Other than the necrotizing bullous lesions on the bilateral legs, there were no other noteworthy physical examination findings. The back and abdomen were unharmed. No contractions; NST was cat1 reactive.
Figure 2: Bullua and ulcerations on the right and left legs.