Extensive and Erosive Facial Dermatosis

Presented by Douglas Johnson, M.D.
Honolulu, Hawaii

This 63 yo Korean woman presented to the ER with fatigue.

Noted to have large ulcerated plaque on the right forehead and frontal scalp. She had been seen in wound clinic on one occasion 2 years before and at the time was noted to have a 2 x 2.5 cm ulcer on the right forehead.

 

 

Her recent Hgb was 3.3 grams. Endoscopy revealed a gastric ulcer with no evidence of bleeding. There was no history of dark stools.

The patient believes that this was caused by a cosmetic procedure she had done in Korea by a plastic surgeon many years ago.

Seems like she may have had a facelift.

Pathology: The initial biopsy revealed a normal epidermis with a heavy mixed inflammatory infiltrate suspicious for infection, although special stains for bacteria, fungi and virus was negative.

Wound culture grew Staph Capre (a commensal organism).

Second routine biopsy and tissue biopsy for cultures is pending.

What are your thoughts as to the diagnosis.