Hidradenitis suppurativa, pyoderma gangrenosum and ulcerative colitis together during pregnancy: bad luck or is there any other explanation?

Objective. We reported a case of the concurrent onset during pregnancy of suppurative hidradenitis (HS), pyoderma gangrenosum (PG) and ulcerative colitis (UC) in a previously healthy woman managed at our referral center.
Materials and Methods. This is a case report about a primiparous, 22-year-old Indian woman who was admitted to our emergency room at 24 weeks of gestation with fever and melena. At the visit, several pustular abscess lesions of the left axillary were found and the rettoscopy suggested UC. Following this, a rash with pustules appeared on her inferior limbs and worsened with the development of painful hemorrhagic ulcers. After a multidisciplinary team consultation, a diagnosis of an overinfected HS of the axilla and PG of the legs associated with UC was made. With antibiotic therapy, high-dose corticosteroid infusion and Mesalazine therapy the melena gradually stopped and, simultaneously, a nearly complete recovery of the cutaneous manifestations of HS and PG was obtained. At 34.5 weeks, she vaginally delivered a healthy neonate of 2200 g.
Results. HS, UC, and PG represent the components of an autoinflammatory immuno-mediated syndrome, called PCHS syndrome, only recently described. This is the first case of PCHS syndrome managed during pregnancy. The close monitoring and the enhancement of one of the associated conditions (UC) lead to the simultaneous improvement of the others, proving the link between these pathologies.

Conclusions. The physiology of pregnancy could create conditions that mimic inflammatory disorders amplifying the risk of developing autoinflammatory diseases in predisposed women. A multidisciplinary approach to the different diseases allowed a favorable course of the pregnancy itself.