Clinical case.
38-year-old female with history of arterial hypertension. One week prior
to admission, she presented an abscess formation in the left cervical
area, with drainage of purulent fluid, and subsequent development of
blisters in both breasts, which are accompanied by 9/10 pain on the
visual analog scale, at the time of the examination. A dermatosis is
seen that affects the region of the thorax, on its anterior face, at the
level of both breasts, symmetrical and localized; This dermatosis is
made up of two ulcers of polygonal morphology which are 11x8cm (Left)
and 9x8cm (Right) in their larger diameters, and are completely covered
by hematic scab and necrotic areas, which follow the anatomical contour
of the breast surrounding the areola and partially affecting it in the
periphery but not affecting the nipple, in the perilesional area there
is erythema and a scale collar, defined edges, apparent acute / subacute
evolution. (Fig. 1)
She received outpatient treatment with unspecified antimicrobial for 7
days without clinical improvement. She came to our institution where we
performed surgical debridement of the devitalized tissue and taking a
culture of the lesions (Fig. 2). In the surgical procedure, we observed
necrosis of the fascia and subcutaneous tissue involvement. The
histopathological study reported the ulcerated epidermis covered by
fibrin, acute inflammation with abscesses and multifocal necrosis in the
dermis and subcutaneous cellular tissue. Adipose tissue with coagulative
necrosis and fibrinoid necrosis of capillaries. Colonies of Moraxella
Catarrhalis grew in the culture of the debrided tissue. (Fig 3)
She received treatment with meropenem 1gr IV every 8 hours according to
antibiogram sensivity resting and (VACĀ® therapy) with 3 replacements.
Once the surgical bed was adequate and negative culture for
microorganisms, application of partial thickness skin grafts was
performed; presenting a genuine clinical improvement. (Fig. 4)
Follow up was performed in two months and the patient was satisfied with
the results without presenting complications. (Fig. 5)