https://doi.org/10.4081/ecj.2024.12790

That purplish huge hole on the chest wall

Early Access
Published: 23 August 2024
Pyoderma Gangrenosum, skin diseases, ulcer, skin lesions, thoracic surgery, VATS
Abstract Views: 1780
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Authors

Paola Rienzo
https://orcid.org/0009-0004-5682-7848
Emergency Department, San Raffaele Hospital IRCCS, Milan, Italy.
Erika Poggiali
poggiali.erika@gmail.com
Emergency Medicine Unit, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milan, Italy.

A 54-year-old woman presented to our emergency department two months after the removal by Video-Assisted Thoracoscopic Surgery (VATS) of her middle lung lobe affected by severe inflammation and fibrosis. She was experiencing pain from a large ulcer (diameter 13 cm) starting from the surgical scar. She suffered from Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia (CREST) syndrome, and hypothyroidism. The laboratory results showed White Blood Cell count (WBC) 13,600/mm3 (N 76%), C-Reactive Protein (CRP) 12 mg/L (nv<6), and Erythrocyte Sedimentation Rate (ESR) 86 mm/h (nv<20). Repeat skin swabs were always negative. Skin biopsy documented granulocyte infiltration in the dermis-hypodermis with tissue necrosis. For three weeks, the patient was treated with methylprednisolone 1 mg/Kg IV and colchicine 0.5 mg q12h orally. In the absence of a good response, oral cyclosporine 75 mg q12h was added. The ulcer gradually improved within a week. The pain was successfully treated with paracetamol 1 gr q8h IV.

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How to Cite

Rienzo, P., & Poggiali, E. (2024). That purplish huge hole on the chest wall. Emergency Care Journal. https://doi.org/10.4081/ecj.2024.12790
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