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)