Agminated Pyogenic Granuloma–Like Growth Arising in a Congenital Hemangioma

Abstract

several months. Our patient was without hydroxyurea for 2 months and showed no improvement. Only after the hydroxyurea therapy was discontinued permanently was her ulcer finally able to resolve with medical and surgical intervention. Another complicating factor in our patient's wound healing was the immunosuppressive effects of the prednisone and azathioprine, which likely led to intermittent superinfection and prevented the ulcer from healing on its own. Why does hydroxyurea cause cutaneous ulceration? Almost all patients taking hydroxyurea develop megaloblastic erythrocytes within 24 hours, causing decreased susceptibility to deformation that impairs capillary blood flow to the skin. 4,5 The result is cutaneous anoxia followed by ulceration. This mechanism may explain why the malleolus, a frequent site of trauma, is a common location for these ulcers. In our patient, the ulcer developed after cryotherapy, which led to skin breakdown and ultimately ulceration. MTHFR polymorphisms, such as the homozygous C→T substitution at nucleotide 677 found in our patient and in 10% to 13% of the white population, can lead to arterial occlusive disease and ulceration. This results from decreased enzyme activity, which causes an increased total homocysteine level in the presence of suboptimal folate intake. 6 The concurrent existence of an MTHFR polymorphism or other thrombophilic genetic mutation in a patient taking hydroxyurea could be the complicating insult that leads to cutaneous ulceration. Therefore, we recommend screening for an array of coagulation abnormalities that predispose to thrombophilia (including MTHFR polymorphisms) in patients with ulcers unresponsive to standard therapy as well as the use of B vitamin supplementation in patients with a MTHFR polymorphism. Future studies looking at MTHFR polymorphisms in patients with hydroxyurea-induced ulcers may solidify this association.

Partially involuting congenital hemangioma with pyogenic granuloma‐induced rapid progression following incisional biopsy in infancy: A case report

“…This may have been caused by pyogenic granuloma, a complication resulting from infection at the biopsy site. Symptoms of pyogenic granuloma include friable granulation tissue‐like changes and hemorrhage, and the histopathological findings reveal granulomatous microvascular proliferation, which is consistent with the present case 7 . To date, only two cases of pyogenic granuloma complicating congenital hemangioma have been reported 7,8 .…”

“…Symptoms of pyogenic granuloma include friable granulation tissue‐like changes and hemorrhage, and the histopathological findings reveal granulomatous microvascular proliferation, which is consistent with the present case. 7 To date, only two cases of pyogenic granuloma complicating congenital hemangioma have been reported. 7 , 8 In one case, friable granulation tissue‐like changes with bleeding spontaneously developed within an infant's congenital hemangioma located on the mandible.…”

Coexistence of kaposiform hemangioendothelioma and capillary malformation: More than a coincidence? Two case reports

“…Few studies have reported the relatively common coexistence of vascular tumors and vascular malformations, such as pyogenic granuloma (PG) arising with CM and PG arising in a CH [ 9 , 10 ]. Combined capillary-venous-lymphatic malformations without overgrowth in patients with Klippel-Trénaunay syndrome have been reported [ 11 ].…”

Co-Occurrence of Natal Teeth With Rapidly Involuting Congenital Hemangioma: A Case Report

“…Some lesions may ulcerate, bleed or leave a scar. Other complications include pyogenic granuloma-like growth [7], a life threatening hemorrhage and thrombocytopenia [1,8]. Although most hemangiomas are isolated anomalies, several studies have reported that hemangiomas may run in families as an autosomal dominant trait suggesting the involvement of causative genetic factors [9].…”