Transient Phagocytic Dysfunction Mimicking Chronic Granulomatous Disease: A Rare Complication in Delayed Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction
Abstract
Autologous breast reconstruction depends on intact wound healing. Chronic granulomatous disease (CGD) results from nicotinamide adenine dinucleotide phosphate oxidase dysfunction and predisposes patients to opportunistic infections; acquired forms can transiently mimic the congenital disorder. We report a case of transient phagocytic dysfunction that complicated delayed transverse rectus abdominis myocutaneous flap reconstruction. A 43-year-old woman with Stage IIB breast cancer underwent delayed reconstruction 18 months after cytotoxic chemotherapy. A delay procedure (inferior epigastric vessel ligation) was performed 14 days before flap elevation to reduce ischemic risk. When atypical wound failure developed postoperatively, deep tissue biopsies grew opportunistic pathogens (Pseudomonas putida, Staphylococcus epidermidis, and Candida tropicalis) and immune workup was initiated. Neutrophil oxidative function was assessed by dihydrorhodamine (DHR) 123 flow cytometry. Initial DHR testing showed absent oxidative burst (oxidation index 5.0), indicating severe phagocytic dysfunction. Targeted antimicrobials (levofloxacin, fluconazole) and negative pressure wound therapy were started. Repeat DHR at 6 weeks was fully normal (oxidation index 58.80), excluding genetic CGD. The patient healed completely by secondary intention without further surgery. Phagocytic dysfunction can emerge as a late sequela of cytotoxic therapy and complicate autologous reconstruction, mimicking genetic…
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Ferulic acid regulates the AKT/GSK-3β/CRMP-2 signaling pathway in a middle cerebral artery occlusion animal model
- Novel Pharmacokinetic/Pharmacodynamic Parameters Quantify the Exposure–Effect Relationship of Levofloxacin against Fluoroquinolone-Resistant Escherichia coli
- Photochemical behavior of levofloxacin
- Correlation Between Dissolution Profiles of Salt-Form Drugs in Biorelevant Bicarbonate Buffer and Oral Drug Absorption: Importance of Dose/ Fluid Volume Ratio
- Evaluation of the synergistic potential and mechanisms of action for de novo designed cationic antimicrobial peptides
- Synthesis of [11C]levofloxacin
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.