Surgical debridement of infected necrobiotic xanthogranuloma: a case report and review of the literature
Keywords:Necrobiotic xanthogranuloma, Necrobiosis, Surgical excision, Debridement, Infection
Necrobiotic xanthogranuloma (NXG) is a rare skin disorder characterized by the development of large violaceous plaques all over the body. Rarely, these plaques become infected and require surgical debridement. The current literature is lacking on outcomes of surgical intervention in this patient population. Hence this case report aims to describe surgical management for a patient with NXG presenting to The Shoalhaven District Memorial Hospital and review the literature on the pathophysiology and current treatment modalities for this condition. A 61-year-old man presented to The Shoalhaven District Memorial Hospital with an infected NXG plaque on his left calf unresponsive to intravenous antibiotics. He has had a previously infected lesion on his right shin debrided by our surgical team in 2015, with plaque recurrence on the superior-medial aspect. His current infection was managed with surgical excision of the necrotic core of the NXG plaque while sparing the healthy surrounding plaque tissue. This is in accordance to the current literature which demonstrates poor cosmetic outcomes with complete surgical resection of healthy plaques, with a 42% recurrence with increased size and nodularity.1, 2 NXG appears to be related to autoimmune monoclonal paraproteinemia and associated with hematological malignancy. Therefore, management is primarily medical with surgical resection only indicated in cases of severe infection. NXG presents a rare challenge to the general surgeon given the lack of evidence for surgical debridement. Understanding the underlying pathophysiology, treatment options and healing patterns in this disorder will allow the surgeon to assess and manage infected lesions with minimal cosmetic disfigurement
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