Track: Case Reports

Abstract:

Myospherulosis is a rare iatrogenic condition, histologically characterized by aggregates of necrotic erythrocytes that can resemble fungal elements. Although it is most frequently observed in sinus cavities or post-surgical sites, cutaneous manifestations can also occur, though they are uncommon. We report the case of a 79-year-old male who developed persistent, draining nodules on his left medial thigh and knee approximately five months after undergoing adhesive therapy (Venaseal injection) of the left great saphenous vein for chronic venous insufficiency. The lesions persisted despite treatment with warm compresses, oral antibiotics, and topical antibiotics. Excisional biopsies revealed a muscular vessel with necrotizing granulomas, lipomembranous fat necrosis, fibrosis, and aggregates of necrotic erythrocytes consistent with myospherulosis. Microbiologic cultures showed no evidence of infectious organisms. The lesions were anatomically aligned with the previously treated vein, suggesting a localized vascular destructive process with reactive changes, likely secondary to adhesive therapy. This case underscores a rare cutaneous presentation of myospherulosis, likely triggered by vascular adhesive treatment. Awareness of this entity is essential to avoid misdiagnosis as an infectious or neoplastic process and to prevent unnecessary patient interventions.

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Eric Yang