Two cases of giant pyogenic granuloma of scalp
A 28-year-old male presented with a dirty white colored fluffy swelling on the scalp of 10 days duration. Patient had a history of a scalp injury in a road traffic accident 17 days back, for which suturing was done at a private clinic. Patient did not clean the wound or wash scalp for the next 17 days. Sutures were not removed. He developed an asymptomatic swelling at the same site about 10 days after suturing which gradually grew in size. On cutaneous examination, a friable dirty cream white colored, soft, multi-lobular hemispherical swelling of 4 cm × 4 cm was seen on the left fronto parietal area of scalp []. On palpation, the swelling was non-tender and the base was adherent to the scalp, with bleeding from the base on manipulation. On firm pressure, the swelling was yielding and breaking like a empty gelatinous egg shell. Differential diagnosis considered were: Foreign body reaction to retained sutures, PG and mucormycosis, squamous cell carcinoma.\nPatient was negative for serologica l test for HIV and syphilis. Other routine investigations were with in normal limits. Scraping for fungal filaments and fungal culture were negative. Biopsy from the swelling revealed focally ulcerated epidermis with ulcerated area showing granulation tissue with proliferating fibroblasts and blood vessels []. Dense inflammation composed of lymphocytes, plasma cells, few PMN, and eosinophils. No evidence of granuloma or neoplasm was observed. Pathologist opined that it was a reactive pattern similar to PG with ulceration and exuberant granulation tissue amid dense acute-on-chronic inflammation.\nPatient was given systemic antibiotics, oral metronidazole, and topical betadine. The swelling regressed gradually in size over a period of 5 weeks, leaving behind an adherent crust. Sutures were removed by removing the crust only after swelling regressed completely.