Case Study

Clara Maino, Daniela Villa, Chiara Bernabò

Vincenzo Bergamo, Annamaria Raimondi

Ambulatorio Ferite Difficili / DPS

ASST Monza – via Pergolesi 33 20900 Monza

c.maino@asst-monza.it

Case study

Female, 49 years old affected by Rheumatoid Arthritis treated chronically with steroids.

We have been consulted for severe deep ulcerated lesions of both legs starting from indolent blisters, involving tendon exposure : amputation has been suggested.

Swabs resulted positive for Morganella morganii and MRSA.

She was hospitalized for systemic antibiotic therapy after appropriate investigations to rule out osteomyelitis. We started with VAC Ulta every 3 hours/ “choice” dressing and saline.

At admission

After 7 days lesions dramatically improved with extensive granulation and Plastic Surgeon was consulted to decide the appropriate time for skin graft repair.

After 7 days

Grafts were done and patient discharged after few days.

At 3  and 6 months followup skin was remarkably healed with no more ulcers occurring.

This case was emblematic of the indication of the system to prepare even severe deep lesional beds to skin grafts.

The origin of the blister dermatitis evolving in deep ulcers was attrbuted to a dermoepidermic ungluing but no clear correlation was suspected with RA itself or chronic steroid therapy.