A 34-year-old patient (gravida 4, para 2) in her 34th week of pregnancy underwent cesarean section (C-section) for nonreassuring fetal status due to clinical chorioamnionitis. Her medical history was unremarkable without inflammatory bowel disease, arthritis, or hematologic disorders, and her previous pregnancies were uneventful. At 5 days postpartum, erythema appeared around the operative wound. Although antibiotics were started for a suspected wound infection, violaceous erythema and erosions developed at the periphery of the wound, gradually extending to form a surrounding ulcer.
PG is an uncommon neutrophilic dermatosis that leads to painful and necrotic ulceration. Fifty percent of cases are associated with an underlying systemic disease, most commonly inflammatory bowel disease, arthritis, or hematologic disease (Ahronowitz et al., 2012). Steele et al. (2016) suggested that immunologic alterations during pregnancy may predispose some patients to PG. The authors described three major mediators involved in both PG and pregnancy: 1) progressive alteration toward T helper (Th) 1 cells and Th17 predominance during the third trimester of pregnancy, 2) overexpression of granulocyte-macrophage colony-stimulating factor, and 3) increased numbers of neutrophils.