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Allergy and Clinical Immunology

Rash and Poor Wound Healing After Mastectomy

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA

Published Online: August 29, 2023

JAMA Clinical Challenge

Article Information and Disclosures

Austinn C. Miller, MD^1,2;

Vladimir Ratushny, MD, PhD^1,3;

Armand B. Cognetta Jr, MD^1,2,3

Author Affiliations

¹Dermatology Associates of Tallahassee, Tallahassee, Florida
²University of Central Florida/HCA Consortium, Tallahassee
³Mohs Micrographic Surgery Unit, Division of Dermatology, Florida State University College of Medicine, Tallahassee

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A 42-year-old woman with asthma, seasonal allergies, and invasive ductal breast carcinoma presented to the dermatology clinic for rash and poor wound healing 2 weeks after bilateral mastectomy. Five days after surgery, the patient noted erythema, edema, pain, pruritus, and serous fluid drainage at the mastectomy incision sites (Figure 1). Two days later, she developed an erythematous papulovesicular rash on her trunk and upper and lower extremities. A skin swab was sent for bacterial culture, and she was prescribed cefadroxil (500 mg twice daily for 1 week). The skin swab bacterial culture result was negative, and her skin findings did not improve with antibiotics. The patient reported having a similar episode of rash and delayed wound healing after laparoscopy 1 year prior to presentation.

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A 42-year-old woman with asthma, seasonal allergies, and invasive ductal breast carcinoma presented to the dermatology clinic for rash and poor wound healing 2 weeks after bilateral mastectomy. Five days after surgery, the patient noted erythema, edema, pain, pruritus, and serous fluid drainage at the mastectomy incision sites (Figure 1). Two days later, she developed an erythematous papulovesicular rash on her trunk and upper and lower extremities. A skin swab was sent for bacterial culture, and she was prescribed cefadroxil (500 mg twice daily for 1 week). The skin swab bacterial culture result was negative, and her skin findings did not improve with antibiotics. The patient reported having a similar episode of rash and delayed wound healing after laparoscopy 1 year prior to presentation.

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Article Information

Corresponding Author: Austinn C. Miller, MD, Dermatology Associates of Tallahassee, 1707 Riggins Rd, Tallahassee, FL 32308 (millerpublication@gmail.com).

Published Online: August 29, 2023. doi:10.1001/jama.2023.16367

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported in whole or in part by HCA Healthcare and/or an HCA Healthcare-affiliated entity.

Role of the Funder/Sponsor: The authors were independent and unrestricted in the preparation, review, and approval of the manuscript and the decision to submit the manuscript for publication.

Disclaimer: The views expressed in this publication represent those of the authors and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

Additional Contributions: We thank the patient for providing permission to publish this information.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.