Unusual development of granulomas on the healing surface of burn wounds associated with MRSA infections

Abstract

Ten patients with a mean age of 14.5 years and partial skin thickness burns involving 3-5 per cent body surface areas developed rapidly proliferating tumour-like growths on the surface of their healing wounds within 10-21 days of sustaining the injuries. The number of tumours on every patient was either single or multiple and each increased in size daily. The growths were unique in their fulminatingtype fleshy mass, with a consistency varying from soft to firm, absence of purulent material or head, and extension up to the fibrous layer covering the musculature. Histopathology was suggestive of granulomatous rather than a suppurative nature of the lesions. Isolation of MRSA from the burn wounds of four cases on the first day of dressing and then from the surface of the tumours of all of them and the excised tissues, as well as from the environment of the dressing room, indicated its involvement in the causation of the growths through contaminations of wounds with a hospital endemic strain while handling or dressing. The organisms were resistant to most antibiotics except vancomycin and teicoplanin. The growths in four cases subsided within 72 h with daily dressing, using an injectable solution of either vancomycin or teicoplanin, while the rest required radical excision and immediate cover with split skin grafts and systemic administration of either of the antiobiotics. The wounds healed over a period of 8-10 days.