A 32-year-old white woman, who was undergoing transgender body modifications and no previous medical history, presented to our emergency department (ED) with a chief complaint of right forearm pain, associated with redness and blistering. The patient was a tattoo fanatic who underwent solar branding on her right forearm approximately 2 weeks before presentation. The patient first noticed the blistering of the branded area 3 days after her body modification. Over the next few days, the entire branded area became very warm, swollen, painful to touch, and developed cellulitis with weeping blisters. Given her dire situation, the patient finally sought medical care in the local urgent care center. The patient was diagnosed with a superficial infection of her right forearm full thickness burn and prescribed oral clindamycin. The patient continued to develop painful blisters for the next week and did not notice any improvements in her cellulitis despite the antibiotic treatment, prompting her to come to our ED for a second medical opinion.\nDuring her physical examination, the patient was noted to have painful blisters, redness, and swelling of the right forearm and hand (Figure ). She did have a full range of motion of the hand; however, there was mild pain noted on the flexion of the hand. There were no signs of sepsis, and her vital signs and her laboratory panel which included white blood cell count were all within normal limits. The rest of the physical examination was also unremarkable. The patient was admitted to the Burn Surgery Service for intravenous (IV) antibiotics and possible operative interventions.\nThe patient was started on IV clindamycin 600 mg every 8 hours, and once adequate pain control was achieved, a bedside debridement was performed in the Burn Unit. The following day, the patient was taken to the operating room for tangential excision of her wound and split-thickness skin autograft (STSG) placement onto her right forearm. The left anterolateral thigh was chosen as the donor site. The grafted site was dressed with xeroform, followed by a layer of bacitracin ointment and then wrapped with Kerlex and Coban dressings. A right forearm elbow splint was fitted and placed by the occupational therapy service for further graft protection. Postoperatively, the patient was transferred back to the floors without complications, and antibiotics were stopped. The right forearm dressing was taken down on postoperative day 4 to evaluate the STSG. The entire graft was viable and taken. Subsequently, the graft staples were removed on postoperative day 5.\nThe patient recovered exceptionally well and was discharged home a few days later. Two weeks later, the patient returned to the burn clinic for a follow-up appointment. The skin graft and the donor site healed remarkably well (Figure ). The patient reported no pain and had a full range of motion of the hand and wrist. The patient was discharged from the burn service and advised to use over-the-counter moisturizer or lotion as needed.
A 35-year-old Pakistani male with a history of chronic malaria, progressive splenomegaly and a complaint of severe left sided abdominal pain was treated by branding with a hot metal rod 7 days prior to admission. A week later he was admitted for septic shock and severe pain in the left hypochondrium. Past medical history was noncontributory except for an intermittent low-grade fever and occasional spikes of a high-grade fever with chills. On examination, he was disoriented and had multiple circular full-thickness burns to the anterior abdomen ranging in size from 2 to 5 cm across with central sparing of the skin and yellow discharge from the wounds. Blood and wound cultures grew Staphylococcus aureus. Abdominal ultrasound on admission showed a massively enlarged spleen with multiple rounded areas of complex echogenicity showing multiple splenic abscesses which were not seen in previous ultrasounds. He was treated with broad spectrum antibiotics and silver sulfadiazine. A splenectomy was performed and a gross examination confirmed the existence of multiple splenic abscesses which were also positive for Staph. aureus. Culture of pus from the spleen revealed growth of same Staph. aureus that were present on burn wounds complicated by skin branding. The patient died in the fourth week during the course of treatment.