Resident physician, Chhattisgarh, India
The
patient, an 85 yo man with no known past medical history, presented to our OPD with
large lesion with sinuses tracts on back since past 4 years.
The lesion appeared as small sinus tracts with swelling
over the right sided back. These were
pruritic in nature with slowly & progressively increasing in size
over 1 year & the lesion has not increased in size since past 3
years. There was no history fever
or cough or any other lesions noted. He
is not diabetic nor hypertensive.
No h/o specific medicinal intake or food
allergy noted by the patient preceding the back lesion.
On examination:
A large lesion of approx 25 x 15 cm in size
papular in nature with multiple discharging pustules noted over the same;
scratch marks are present..
Swelling firm in consistency; & skin
over the lesion is non-adherent to the lesion; Lesion is freely mobile over the
base of scapula & muscles.
Clinical Photos:
There are no specific systemic finding.
We approached this skin lesion as mycetoma
or fungal infection; Scrofuloderma was also one of the D/D. But the skin biopsy
revealed “Lobular Capillary Hemangioma.”
Path Report:
Path Report:
What other D/Ds can this lesion be??
How should we treat such lesion? How long
can we treat this patient medically??
What specific counselling in terms of resolution
of skin lesion should be done for the patient?
When can we consider surgical option (?
wide excision); if any? What are the specific indications of the surgical
removal of the lesion?
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