Case Series/Study

(CS-027) Wound Biopsies of Atypical Wound Presentations Lead to the Diagnosis of Rare Disease States: a Case Study

Co-Author(s):

Introduction: The prevalence of atypical wounds has not been studied extensively, but it has been estimated that 20% of all chronic wounds are due to unusual causes. As our population ages clinicians are caring for patients with increased numbers of comorbidities and pathological processes that can contribute to the development of hard-to-heal wounds.<span lang="EN" style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: major-latin; mso-fareast-font-family: 'Times New Roman'; mso-hansi-theme-font: major-latin; mso-bidi-theme-font: major-latin; background: white; mso-highlight: white;"> Therefore, clinicians should have a high index of suspicion for atypical wound etiologies and skin condition in wounds that fail to heal with standard of care. Methods: <span lang="EN" style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: major-latin; mso-fareast-font-family: 'Times New Roman'; mso-hansi-theme-font: major-latin; mso-bidi-theme-font: major-latin;">This case series details the clinical and histological appearance of 3 atypical wound encountered by the author-Granular Parakeratosis, Bullous Disseminated Herpes Zoster and Pancreatic Panniculitis. 
<span lang="EN" style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: major-latin; mso-fareast-font-family: 'Times New Roman'; mso-hansi-theme-font: major-latin; mso-bidi-theme-font: major-latin;"> 
Detailed medical, travel, recreational and occupational histories were obtained to assure an accurate diagnosis was made. In addition, a physical exam and wound assessment including wound measurement, location, staging, tissue character and color, odor, exudate quality and amount, peri-wound tissue appearance, and pain were noted for each patient. In each case, these chronic wounds persisted despite appropriate wound care treatments therefore typical wound etiologies were ruled out based on tissue biopsies and additional diagnostic testing.
<span lang="EN" style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: major-latin; mso-fareast-font-family: 'Times New Roman'; mso-hansi-theme-font: major-latin; mso-bidi-theme-font: major-latin;"> Results: <span lang="EN" style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: major-latin; mso-fareast-font-family: 'Times New Roman'; mso-hansi-theme-font: major-latin; mso-bidi-theme-font: major-latin; color: black; mso-ansi-language: EN; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">In this case series, these chronic ulcers exhibited random clinical features, histology, and location. Resistance to standard therapies and difficulty in diagnosing could have resulted in delayed treatment.<span lang="EN" style="font-size: 11.0pt; line-height: 115%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: major-latin; mso-fareast-font-family: 'Times New Roman'; mso-hansi-theme-font: major-latin; mso-bidi-theme-font: major-latin; color: black; mso-ansi-language: EN; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;"> <span lang="EN" style="font-size: 12.0pt; line-height: 115%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: major-latin; mso-fareast-font-family: 'Times New Roman'; mso-hansi-theme-font: major-latin; mso-bidi-theme-font: major-latin; mso-ansi-language: EN; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Timely tissue biopsies and examination of histopathology revealed the presence of distinctive clinical features consistent with several extremely rare pathological states Discussion: Identifying an atypical wound can be a difficult undertaking. If a chronic wound persists despite appropriate wound care treatments, then typical wound etiologies should be ruled out. Atypical wounds are rare, and their pathophysiology is not well understood. The diagnosis and management of these ulcer types is a real challenge to physicians. Skin biopsy plays a pivotal role in making the diagnosis and should be performed in all cases of refractory wounds. 
 
 
 
 
 
 
 Trademarked Items: References: • Shah JB, Hamm R. Atypical Wounds. In Hamm R. Atlas of Wounds and Integumentary Disease. Philadelphia: Lippincott William & Wilkins;2015.
• Cole W. Atypical Wounds: Cracking the Code of the Uncommon. Podiatry Management, August edition 2021.
• Trent, Jennifer T. MD; Federman, Daniel MD; Kirsner, Robert S. MD Skin and Wound Biopsy: When, Why, and How, Advances in Skin & Wound Care: December 2003 - Volume 16 - Issue 7 - p 372-375