PMC7443249_01
(a) Haemorrhagic patch of the parietal, frontal, and occipital regions of the scalp (day 2). (b) Extensive necrotic ulcerations of the parietal, frontal, and occipital regions of the scalp (day 7).
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The lesion started as a haemorrhagic patch of the parietal region of the scalp; then it has subsequently worsened and spread up within 2 days (Figure 1(a)). Physical examination revealed extensive necrotic ulcerations with obvious hyperesthesia in both parietal and temporal regions of the scalp (Figure 1(b)).
(a) A temporal artery biopsy showing a granulomatous vasculitis of vessel walls. (b) Collections of macrophages, neutrophils, and giant cells in the vessels walls.
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A temporal artery biopsy showed a granulomatous vasculitis of vessel walls with collections of macrophages, neutrophils, and giant cells (Figure 2).
(a) 2 weeks after excision of the necrotic ulcerations performed at the maxillofacial department on day 21. (b) Trepanning followed by multiple negative-pressure wound therapy session (day 120). (c) Partial cicatrisation of the scalp necrosis after one year of follow-up.
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Two weeks later, he was referred to maxillofacial surgery department where he underwent during many weeks several surgical operations: excision of the necrotic ulcerations (Figure 3(a)) and trepanning followed by negative-pressure wound therapy (Figure 3(b)). The patient was satisfied with the cosmetic outcome, and cutaneous graft was refused (Figure 3(c)).