Successful non-grafted second-intention healing of a massive gluteal soft-tissue wound complicating septic shock with secondary hemophagocytic lymphohistiocytosis in a patient with type 2 diabetes: a case report
This case report documents the successful complete healing of a massive 18 x 8 cm gluteal wound complicating septic shock and secondary hemophagocytic lymphohistiocytosis in a diabetic patient through systemic stabilization, surgical debridement, and disciplined topical wound care, achieving full second-intention re-epithelialization without the need for skin grafting.
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The human body is a resilient machine, but it has a critical weakness: when the immune system, designed to protect us, turns against itself or goes into overdrive, the damage can be catastrophic. This often happens in people with diabetes, where high blood sugar weakens the body's ability to fight off even minor skin infections. A simple pimple or boil can sometimes spiral into a life-threatening condition where bacteria flood the bloodstream, causing septic shock. In rare cases, this overwhelming infection triggers a secondary crisis called hemophagocytic lymphohistiocytosis, a state where the immune system becomes so hyperactive that it begins to destroy the body's own blood cells and organs. When these conditions strike together, especially in a patient with a massive, open wound near a sensitive area like the buttocks, the standard medical playbook often calls for skin grafts to close the gap. However, grafting is difficult when the patient is too sick to survive the surgery or when the wound is too contaminated. The question remains: can such a devastating injury heal on its own if the body is given the right support?
This story begins with a 53-year-old man in China who had recently been diagnosed with type 2 diabetes. He scratched a small boil on his right buttock, a seemingly harmless act that quickly spiraled out of control. Within days, the area became swollen and painful, and he developed a fever. By the time he reached the emergency room, he was in septic shock, a state where his blood pressure was dangerously low and his organs were failing. His blood tests revealed a terrifying picture: his white blood cell count had plummeted, his platelets were critically low, and his body was producing massive amounts of inflammatory signals. Further investigation showed he had developed secondary hemophagocytic lymphohistiocytosis, a rare and deadly immune disorder where his own immune cells were attacking his blood and organs. He also had a massive, deep wound on his buttock, measuring 18 centimeters by 8 centimeters, filled with dead tissue and pus, located dangerously close to the anus. The wound was infected with a mix of dangerous bacteria, including methicillin-resistant Staphylococcus aureus, and fungi.
The medical team faced a daunting challenge. The patient was too unstable for immediate surgery to remove the dead tissue, and his immune system was too compromised to fight the infection on its own. They first focused on stabilizing his body, using powerful antibiotics to target the specific bacteria found in his wound and steroids to calm his overactive immune system. Once his condition improved slightly, they performed a critical procedure to remove the dead, blackened skin and the necrotic fat underneath. The wound was so large that a standard vacuum dressing could not cover it completely, but the team used it anyway to help drain the thick, foul-smelling pus that had accumulated deep in the tissue. This drainage was vital; it relieved the pressure inside the wound and stopped the constant flow of toxins into his bloodstream.
After the initial drainage, the team shifted to a different strategy for daily care. They cleaned the wound twice a day and applied a special ointment based on traditional Chinese medicine, which contained ingredients like propolis, a type of resin made by bees, and various herbs known for their healing properties. This ointment created a moist, protective layer over the wound. In the days that followed, something remarkable began to happen. Instead of needing a skin graft, the wound started to heal from the edges inward. The team observed the formation of tiny, thread-like strands of new skin growing from the healthy skin around the wound, slowly reaching across the open space. These strands thickened over time, acting as a scaffold for new skin to grow over the fresh, pink tissue that was filling the bottom of the wound.
The healing process was slow but steady. Over the next five months, the wound shrank significantly as the new skin continued to spread across the surface. The patient was discharged after 53 days and continued to care for the wound at home, changing the dressings daily. By March 2025, the wound had closed completely. When the doctors checked on him 16 months later, the massive injury had healed into a flat, pale scar. There was no sign of infection, no deep pits, and no raised, bumpy tissue. The skin had returned to a functional state without the need for any surgical skin grafts.
This case demonstrates that even a massive, contaminated wound in a patient with severe diabetes and a life-threatening immune disorder can heal on its own. The key was not a single miracle cure, but a combination of precise steps: stabilizing the patient's life-threatening immune crisis, aggressively removing the dead tissue, using a vacuum device to drain the deep infection, and then maintaining a clean, moist environment that allowed the body's natural healing processes to take over. The use of a specific herbal ointment helped keep the wound moist and free of harmful bacteria, encouraging the growth of new tissue. While skin grafts are often the standard solution for such large wounds, this report suggests that with careful, consistent care, the body can sometimes repair itself completely, even in the most difficult circumstances. The patient's full recovery serves as a powerful reminder that when the body's defenses are supported correctly, the potential for healing is far greater than previously assumed.
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