Clinicopathologic features of ecthyma gangrenosum: a single integrated health system cohort.

Ecthyma gangrenosum is an uncommon cutaneous eruption that can initially present with painless macules, which rapidly evolve into necrotic ulcers. This study sought to characterize clinicopathologic features of ecthyma gangrenosum from a single integrated health system. Our cohort consisted of 82 individuals diagnosed with ecthyma gangrenosum. Lesions were most commonly found in the lower extremities (55%) and the truncal region (20%). A wide variety of fungal and bacterial etiologies were found among our cohort. The majority of patients with EG were immunocompromised (79%) and 38% of patients also experienced sepsis. The mortality rate seen in our cohort was approximately 34%. No statistical differences in mortality outcome due to EG related complications were seen between pathogen etiology, and distribution or location of lesions. Patients who were septic or immunocompromised died more frequently than non-septic or immunocompetent patients, suggesting poorer prognosis.

Hemorrhagic Vesiculobullous Lesions of Ecthyma Gangrenosum in a Diabetic Patient with Myelofibrosis: A Rare Presentation of Septic Shock without Pseudomonas aeruginosa Bacteremia.

BACKGROUND Ecthyma gangrenosum is a rare skin lesion associated with Pseudomonas aeruginosa, an aerobic gram-negative opportunistic bacterial pathogen. In non-bacteremia patients, sepsis is not a common complication. Immunocompromised patients are more commonly affected. If diagnosis and therapy are delayed, the mortality rate is 18-96%. This report is of a 52-year-old man with diabetes mellitus and myelofibrosis presenting with hemorrhagic vesiculobullous lesions of ecthyma gangrenosum on the upper and lower extremities, oral mucosa, and anogenital area with, interestingly, no associated Pseudomonas aeruginosa bacteremia. CASE REPORT A 52-year-old diabetes patient with myelofibrosis presented with hemorrhagic vesiculobullous and necrotic eschar-covered erosions over the upper and lower extremities, oral mucosa, and anogenital area. Although he appeared septic looking initially, with signs of end-stage organ failure, and he was later determined to have septic shock, the clinical diagnosis was not possible without a positive culture swab of the cutaneous lesions showing growth of Pseudomonas aeruginosa. The diagnosis of cutaneous ecthyma gangrenosum-induced septic shock was confirmed, though bacteremia was not detected. This patient was successfully managed with the early initiation of proper antibiotics. CONCLUSIONS Early detection and vigilance when confronted with the clinical presentation of ecthyma gangrenosum are a vital part of patient management to reduce the high mortality risk of the disease. Although bacteremia is associated with a high risk for fatalities, cutaneous ecthyma gangrenosum can be complicated by septic shock and serious adverse events. The involvement of multidisciplinary teams in patient management is an essential aspect of ecthyma gangrenosum disease management.

Ecthyma gangrenosum and severe neutropenic sepsis caused by Staphylococcus aureus infection in a previously healthy child: a case report.

Ecthyma gangrenosum (EG) is a potentially lethal skin infection mainly caused by Pseudomonas aeruginosa, but other causative pathogens have also been reported. EG usually occurs locally and often arises in immunocompromised patients. The fatality rate can be extremely high if a systemic infection leading to sepsis occurs. EG and severe sepsis caused by Staphylococcus aureus infection are extremely rare in healthy children. However, upon occurrence, disease progression can be rapid, and the mortality rate is high. This current case report describes a previously healthy child with no underlying diseases who developed EG in the facial and perianal regions following S. aureus infection. The infection rapidly progressed to sepsis, septic shock, and persistent severe neutropenia. The patient also developed drug-resistant bacterial infections that spread rapidly and resulted in multiorgan failure. The patient was treated with antibiotics, but she died of organ failure despite extracorporeal membrane oxygenation support. EG caused by S. aureus has the potential to progress rapidly, leading to septic shock and severe neutropenia. Patients should be identified at an early stage and promptly treated with antibiotics. However, the improvement of neutropenia and prevention of secondary infections remain the focus of our research.

Ecthyma gangrenosum caused by Staphylococcus aureus in hematological malignancies: Case reports and literature review.

RATIONALE: Ecthyma gangrenosum (EG) is a potentially life-threatening, systemic infection generally caused by Pseudomonas aeruginosa. Data on EG caused by Staphylococcus aureus in patients with hematological malignancies are scarce. The present case report aimed to describe the clinical features of EG caused by S. aureus in patients with hematological malignancies and to provide a comprehensive review of previous studies on the topic. PATIENT CONCERNS: The first patient was a 61-year-old man with acute myeloid leukemia who presented fever and multiple lesions during chemotherapy. The second patient was a 47-year-old man with myelodysplastic syndrome who developed progressive erythematous necrotic plaques on his extremities and face. DIAGNOSIS: Both cases were diagnosed as EG caused by S. aureus. While the first patient had concurrent methicillin-resistant S. aureus (MRSA) bacteremia, the second patient had positive results only for tissue culture of the skin lesion isolated methicillin-sensitive S. aureus. INTERVENTIONS: Vancomycin was initiated with critical care to the first patient. Cefazolin was administered to the second patient for 3 weeks, followed by cephalexin for 1 week. OUTCOMES: The first patient died of a brain hemorrhage and multiple organ failure. The second patient was cured without relapse. LESSONS: Of 18 patients in the previous and current studies with EG caused by S. aureus, 6 (33%) had an underlying hematological malignancy, and 10 (56%) had EG caused by MRSA. While 28% of the patients had positive blood cultures, all tissue cultures were positive. All 3 fatalities had concurrent bacteremia (MRSA caused two). EG caused by MRSA with concurrent bacteremia can be fatal, especially in patients with hematological malignancies. Although S. aureus-associated EG in patients with hematological malignancies is relatively uncommon, tissue cultures with an initial gram stain smear are essential for selecting appropriate empirical antimicrobials, including the coverage of S. aureus.

Ecthyma Gangrenosum in Children With Cancer: Diagnosis at a Glance: A Retrospective Study From the Infection Working Group of Italian Pediatric Hematology Oncology Association.

BACKGROUND: To depict ecthyma gangrenosum (EG) clinical presentation and evolution in a large multicenter pediatric retrospective collection of children with malignancies or bone marrow failure syndromes, to facilitate early diagnosis. METHODS: EG episodes diagnosed in the period 2009-2019 were identified by a retrospective review of clinical charts at centers belonging to the Italian Pediatric Hematology Oncology Association. RESULTS: Thirty-eight cases of EG occurring in children (male/female 16/22; median age 5.2 years) with hematologic malignancy (29), allogeneic stem cell transplantation (2) or relapsed/refractory solid tumor (3) were collected. The involved sites were: perineal region (19), limbs (10), trunk (6), head and the iliac crest (3). Bacteremia was present in 22 patients. Overall, the germs isolated were Pseudomonas aeruginosa (30), Stenotrophomonas maltophilia (3) and Escherichia coli (1); 31% of them were multidrug-resistant. All patients received antibacterial treatment, while surgery was performed in 24 patients (63.1%). Predisposing underlying conditions for EG were severe neutropenia (97.3%), corticosteroid treatment (71%) and iatrogenic diabetes (23.7%). All patients recovered, but EG recurred in 5 patients. Nine patients (24%) showed sequelae (deep scars, with muscle atrophy in 2). Four patients (10.5%) died, 1 due to relapse of EG with Carbapenem-resistant Enterobacteriaceae co-infection and 3 due to the progression of the underlying disease. CONCLUSIONS: EG requires early recognition and a proper and timely treatment to obtain the recovery and to avoid larger necrotic lesions, eventually evolving in scarring sequelae.

An Eschar-like souvenir from a journey to Colombia: Ecthyma gangrenosum as a differential diagnosis of tropical diseases in immunocompromised patients - a case report.

BACKGROUND: Ecthyma gangrenosum (EG) is a cutaneous infectious disease characterized by eschar-like skin ulcers typically caused by Pseudomonas aeruginosa. Here, we report a case of relapsing EG in a patient who had returned from a trip to Colombia, thus establishing EG as an important differential diagnosis of tropical diseases, and demonstrating that even long-term antibiotic treatment can result in only partial remission of EG. CASE PRESENTATION: A 77-year-old man with underlying chronic lymphocytic leukemia (CLL) on ibrutinib treatment was admitted because of a superinfected mosquito bite on the left ear and multiple partially necrotic skin lesions disseminated all over the entire body five days after returning from a trip to Colombia. The initial clinical suspicion of a tropical disease (leishmaniosis, systemic mycosis, or others) could not be confirmed. During the diagnostic workup, microbiological cultures of the skin biopsies and bronchoalveolar lavage revealed Pseudomonas aeruginosa, leading to a diagnosis of EG. Initial antibiotic treatment resulted in partial remission. However, the patient had to be re-admitted due to a relapse 3-4 weeks after the first episode. Finally, the patient was successfully treated with a combined approach consisting of antibiotics, recurrent surgical incisions, and administration of immunoglobulins. CONCLUSIONS: In conclusion, EG should be considered as a differential diagnosis in immunosuppressed patients presenting with eschar-like skin ulcers. A combined treatment approach seems to be the best choice to achieve clinical cure and avoid relapse.

Nen de 9 anys trasplantat cardíac I renal amb lesió dolorosa a l'engonal / No disponible

No disponible

Echtyma gangrenosum caused by coinfection with group A Streptococcus and Staphylococcus aureus: an emerging etiology? Case reports and literature review.

Ecthyma gangrenosum (EG) is a potentially lethal skin infection, most commonly due to Pseudomonas aeruginosa with bacteremic dissemination and affecting mostly immunocompromised patients. We present two cases of EG in two men in Belgium recently admitted to our hospital, caused by a suspected coinfection by group A Streptococcus and Staphylococcus aureus, with a cutaneous dissemination, in which multiple impetigo lesions were the portal of entry. The first patient had no risk factors nor immunodeficiency, but the second was a homeless man with drug and alcohol abuse and advanced HIV infection. Early management of the condition is crucial, with initial broad spectrum antibiotherapy, rapidly narrowed down to the germs identified and skin lesion debridement if necessary. Any immunocompromising condition must be ruled out in any patient suffering from EG.

[A young man with a skin lesion after chemotherapy]. / Een jongeman met een huidafwijking na chemotherapie.

Ecthymagangrenosum is a painful node that rapidly progresses to a necrotic ulcer and occurs as a result of a local infection or hematogenous spread. It has a high mortality rate when treatment is delayed. We describe a 19-year-old male with neutropenic fever due to ecthymagangrenosum caused by Pseudomonas aeruginosa without bacteremia.

Ecthyma Gangrenosum of Scrotum in a Patient with Neutropenic Fever: A Case Report.

BACKGROUND Ecthyma gangrenosum is an uncommon cutaneous infection commonly caused by Pseudomonas aeruginosa affecting typically immunocompromised patients. The presence of ecthyma gangrenosum can be associated with severe systemic infection often with a fatal prognosis. Most cases of ecthyma gangrenosum occur around the axilla, buttocks, and limbs; the scrotum is rarely affected. CASE REPORT A 68-year-old male with previously diagnosed acute myeloid leukemia, presented with left scrotal pain, fever, and rigors. Physical examination showed 2 ulcerating lesions with central black eschars surrounded by erythematous halos on the superior aspect of the left scrotum. Diagnosis of ecthyma gangrenosum was confirmed as both blood and lesion cultures showed growth of P. aeruginosa. After early empiric antibiotic treatment, the lesions significantly improved, and no sign of recurrence or new lesions was noticed. CONCLUSIONS Ecthyma gangrenosum should be considered in the differential diagnosis of ulcerating lesions of the scrotum. An early diagnosis and aggressive antibiotic treatment are imperative for resolution of this infection.

Ecthyma gangrenosum in a 3-year-old boy post-heart transplantation.

Ecthyma gangrenosum (EG) is a serious bacterial infection in immunocompromised patients. EG in transplant recipients is rarely reported and may go unrecognized, which may delay initiation of appropriate treatment. We report a case of EG in a pediatric heart transplant recipient who was treated successfully with antibiotics and surgical debridement.

Juvenile ecthyma gangrenosum caused by Pseudomonas aeruginosa revealing an underlying neutropenia: case report and review of the literature.

BACKGROUND: Ecthyma gangrenosum (EG) is characterized by the occurrence of erythematous, violaceous or haemorrhagic macules and/or vesicles, often evolving into necrotic ulcers, with a central grey-black eschar. It is a rare skin condition, usually occurring in immunocompromised patients suffering from bacterial sepsis caused by Pseudomonas aeruginosa. However, seemingly healthy children have been diagnosed with this skin disease as well. OBJECTIVES: We report the workup of a case of vulvar EG caused by P. aeruginosa in a toddler, which led to a diagnosis of an underlying neutropenia. Moreover, we provide a brief literature review on those cases of EG where an underlying primary immunodeficiency, neutropenia in particular, was eventually diagnosed. METHODS: A one-and-a-half-year-old girl presented with a history of recurrent (respiratory) infections and the sporadic occurrence of purpuric, vulvar ulcers. Workup consisted of microbiological and haematological investigations, including repeated blood analyses. RESULTS: Bacterial swabs from the vulvar ulcers showed the growth of P. aeruginosa. No concomitant sepsis was present, but laboratory investigations pointed towards a cyclic neutropenia, coinciding with the occurrence of the EG lesions. Topical gentamicin ointment allowed the skin lesions to heal faster. Following the administration of granulocyte colony-stimulating factor (G-CSF), the girl experienced less infections in general and had no recurrence of EG lesions in particular. Treatment with G-CSF could eventually be stopped, and the neutropenia, ultimately transient in nature, completely resolved. CONCLUSION: Children presenting with (anogenital) EG should always alert a physician to consider a potentially underlying immunodeficiency, neutropenia in particular.

Hairy cell leukemia presenting with Ecthyma Gangrenosum- a case report.

BACKGROUND: Ecthyma gangrenosum is a cutaneous infectious usually associated with P. aeruginosa. It usually develops In patients with an underlying immunodeficiency. CASE PRESENTATION: A 50-year old mentally disabled white male with a history of epilepsy presented with fever and a painless red macule on his right arm which rapidly progressed to a painful ulcer. Blood and lesion cultures revealed P.aeruginosa, confirming our clinical diagnosis of ecthyma gangrenosum. Subsequently an underlying immune deficit was found, namely patient was diagnosed with hairy-cell leukemia. Despite adequate antibiotics no infection control could be achieved. After treating the underlying immune deficit as well, the infection and hairy-cell leukemia resolved completely. CONCLUSION: Ecthyma gangrenosum is an important cutaneous infection to recognize, because it is it is typically associated with P.aeruginosa bacteremia. Recognizing this skin leasion should prompt empiric antimicrobial therapy including an agent with antipseudomonal activity. Furthermore, just like in our case, the presence of ecthyma gangrenosum can signal the presence of an occult immune deficit, warranting further investigation.

[Ecthyma gangrenosum]. / Ecthyma gangrenosum.

Ecthyma gangrenosum (EG) is a severe potentially lethal cutaneous infection that progresses sequentially from maculopapular rash to haemorrhagic bulla and then to necrotic ulceration with surrounding erythema. It usually occurs in immunocompromised patients (aplasia secondary to chemotherapy, HIV infection, neutropenia or functional deficit of neutrophils, agammaglobulinemia). It rarely affects healthy people. Differential diagnosis includes leishmaniasis, pyoderma gangrenosum, eschars and papulonecrotic tuberculides. Blood cultures and/or local sample allow the isolation of P. aeruginosa, which is the causative germ. Treatment is based on suitable parenteral antibiotic therapy according to results of susceptibility tests (third-generation cephalosporins, fluoroquinolones). We here report the case of a 2-year old child with no particular past medical history presenting with multiple necrotic ulcers on the back with erythematous border evolving in a febrile context. Blood culture was negative. Laboratory tests showed sedimentation rate 30 mm, CRP 80mg/l. Bacteriological sampling of pus revealed pseudomonas aeruginosa. The diagnosis of ecthyma gangrenosum was made. The patient underwent parenteral third-generation cephalosporins. Complete patient recovery with healing occurred after 4 weeks.