Superficial Granulomatous Pyoderma of the Face

A Case Report and Review of the Literature

Sarah M. Persing, MPH; Donald Laub Jr, MD, FACS

Disclosures

ePlasty. 2012;12 

In This Article

Results

The wound healed well until approximately 4 to 5 weeks after surgery when she noticed increasing erythema of her reexcisional scar. The wound began to dehisce and a culture grew methicillin-sensitive Staphylococcus aureus. Despite appropriate antibiotics, she had only slight improvement of her wound. A second biopsy once again demonstrated granulomatous inflammation, and mycobacterial and fungal cultures were taken on these tissue biopsies. No acid-fast bacilli were isolated; fungal culture grew Candida parapsilosis. She did not improve after a course of fluconazole, however. Additional laboratory workup showed negative or normal results.

Approximately 8 weeks after reexcision of the biopsy scar, she had a 5.2×3.2-cm ulcerated erythematous plaque with a pink rim on her right temple with granulation tissue at the bed (Fig 1). A third biopsy specimen was obtained from the reexcised lesion. This biopsy demonstrated reactive epidermal hyperplasia with neutrophil-rich inflammation, focal granuloma formation, and granulation tissue (Fig 2). There were no fungal, bacterial, or mycobacterial organisms identified with appropriate stains and culture.

Figure 1.

Ulcerated plaque at 5 weeks after reexcision of the biopsy scar.

Figure 2.

Tissue biopsy specimen showing reactive epidermal hyperplasia with neutrophil-rich inflammation and focal granuloma formation (hematoxylin-eosin, original magnification ×10).

The diagnosis of SGP was subsequently made on the basis of the clinical and histopathologic characteristics of her presentation. Treatment was initiated with oral prednisone 50 mg daily and mupirocin 2% ointment. At 1-month follow-up, substantial improvement was noted with significant reepithelialization from her prior evaluation (Fig 3).

Figure 3.

Healing lesion after 1 month of prednisone therapy.

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