A 56-year-old woman, born in the Philippines, was admitted to the emergency department of our hospital with fever of more than 39 oC, with the appearance of a painful mass in the anterior cervical region thyroidectomy performed 7 months before.
As a background of interest, it is worth highlighting a picture of ulcerative colitis (UC) in follow-up by the Gastroenterology Service, with a last rectal drill of the disease 3 months before admission, foaming pathologies following treatment with Mesala
Blood tests performed on admission showed leukocytosis of 20,500/μL, with 65% segmented and 14% felled.
Cervical ultrasound was performed. The objective was to perform a topical catheter drainage 4000x4x1cm in emergency area. The patient decided to admit the patient prior to surgery, and the second decided to treat her with a discharge area.
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After 8 days of hospitalization, the patient complained of pain, heat, swelling and erythema of the thenar eminence of the left hand. A new antibiotic treatment with Daptomycin 6 mg/kg was initiated.
Due to the poor evolution of the lesions, a cervical computer tomography (CT) was performed on the left hand, confirming the presence of myotracheal deformities, and magnetic resonance imaging (MRI)
Therefore, it was decided to perform surgical drainage of both lesions.
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The diagnosis of pyoderma gangrenosum based on suspicion after 15 days of admission due to the persistence of negative cultures and the lesions are not only refractory to established treatment (debridement and antibiotic therapy), but also worsen the patients position C
After 25 days of admission, there was no clear improvement in lesions caused by seizures and seizures (G), so we decided to place a loud dressing for both systems due to the lesion and the intense pain reported by the patient during the dressings.
The pressure applied was 110 mmHg, with continuous vacuum application, making changes every 3 days.
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Pretracheal systemic pressure and pressure lesions evolved favorably with negative pressure therapy; however, negative hand lesions were placed in the left hand after the installation of the device and was decided for 200 days after the beginning of treatment.
In this location we used the same system but with a small size format; pressure applied was 110 mmHg continuously and dressing changes were performed every 3 days.
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The patient was discharged after 68 days of admission and went to outpatient care and control by the Departments to home with negative pressureand dressings for the other month, with treatment based on Prednisone 50 mg/day.
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The evolution of the patient was favorable, with complete resolution of the case two months after hospital discharge, without recurrence after 21 months of follow-up.
