Abstract
BACKGROUND: Lobular capillary hemangioma, also known as pyogenic granuloma (PG), is a relatively common benign rapidly growing friable vascular tumor of the skin and mucus membranes. Although the exact pathogenesis of PG is unknown, many theories discussed the potential of an angiogenic stimulus and an imbalance of inducers and inhibitors triggering the hyperplastic and neovascular response. The most frequently used modality for treatment of PG is surgical treatment. The proposed case represents an unexpected evolution to a possible therapeutic measure. CASE DESCRIPTION: We represent a case of a 32-year-old male, known to have T-cell acute lymphoblastic leukemia treated successfully with chemotherapy, currently maintained on methotrexate (MTX) 40 mg and 6-mercaptopurine, 100 mg, presented with 1-month history of painful rapidly growing ulcerated nodules on his right-hand palm and middle finger. Both skin lesions developed approximately 3 months following patient initiation of maintenance treatment. Physical examination revealed two crusted nodules. A proximal lesion was observed over the palmar aspect between the second and third fingers, with the other one occurring alongside the distal phalanx of the third finger, measuring 2.5 cm × 1.5 cm, and 2.5 cm × 3.5 cm respectively. Skin biopsy was obtained from both lesions. The results of the histologic examination both revealed inflamed PG. Tissue cultures of both specimens tested positive for Pseudomonas aeruginosa growth while no fungal and tuberculosis were cultured. Ciprofloxacin 500 mg twice daily, a 2-week course was started. Both lesions completely resolved at 10(th)-day of antibiotic course with no recurrence. CONCLUSIONS: This is a case of a patient with lobular capillary hemangioma of the hand treated successfully with no recurrence using an oral antibiotic. The proposed case represents an unexpected evolution to a possible therapeutic measure. The unexpected role of a conservative measure rather than the conventional surgical method in treating vascular tumors has been highlighted. Moreover, the contribution to an excellent cosmetic outcome has also been demonstrated.