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JAMA Dermatology Clinicopathological Challenge
December 2014

Black Plaques and White Nodules in a Burn Patient

Author Affiliations
  • 1Department of Radiology, Northwestern University Medical Center, Chicago, Illinois
  • 2Department of Pathology, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
  • 3Sumner L. Koch Burn Center, Department of Trauma, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
JAMA Dermatol. 2014;150(12):1355-1356. doi:10.1001/jamadermatol.2014.2463

A man in his 20s sustained a 92% total body surface area (TBSA), full-thickness burn after being doused in gasoline and set on fire. On arrival to the emergency department, the patient was intubated and resuscitated. He underwent emergent chest, bilateral upper and lower extremity escharotomies, and a decompressive laparotomy for abdominal compartment syndrome. Thirteen days after admission, he required a left upper extremity amputation at the level of the proximal humerus owing to development of nonviable muscle tissue that demonstrated black plaques and white nodules (Figure, A and B). Once the patient was hemodynamically stable he was taken to the operating room and underwent 4 operations for debridement and grafting, with the initial operation taking place 10 days after admission. His hospital course was complicated by recurrent polymicrobial aspiration pneumonia, caused by methicillin-sensitive Staphylococcus aureus, Pseudomonas aeruginosa, and Enterococcus. All were successfully treated with antibiotics.

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