That purplish huge hole on the chest wall

A 54-year-old woman presented to our emergency department two months after the removal by Video-Assisted Thoracoscopic Surgery (VATS) of her middle lung lobe affected by severe inflammation and fibrosis. She was experiencing pain from a large ulcer (diameter 13 cm) starting from the surgical scar. She suffered from Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia (CREST) syndrome, and hypothyroidism. The laboratory results showed White Blood Cell count (WBC) 13,600/mm3 (N 76%), C-Reactive Protein (CRP) 12 mg/L (nv<6), and Erythrocyte Sedimentation Rate (ESR) 86 mm/h (nv<20). Repeat skin swabs were always negative. Skin biopsy documented granulocyte infiltration in the dermis-hypodermis with tissue necrosis. For three weeks, the patient was treated with methylprednisolone 1 mg/Kg IV and colchicine 0.5 mg q12h orally. In the absence of a good response, oral cyclosporine 75 mg q12h was added. The ulcer gradually improved within a week. The pain was successfully treated with paracetamol 1 gr q8h IV.