A case report of double etiology of ecthyma gangrenosum: Pseudomonas aeruginosa and Enterococcus faecalis in an immunocompromised child occurred during influenza evolution.

RATIONALE: Ecthyma gangrenosum is a cutaneous infection, most commonly occurring during sepsis evolution with Pseudomonas aeruginosa on an immunocompromised background. There have been rare case reports in previously healthy children and rarer are the cases with double etiology. PATIENT CONCERNS: We present the case of a female Caucasian patient, aged 1 year and 8 months, who developed severe sepsis during flu evolution with predominant respiratory and cerebral manifestations. On admission, at skin level, there was noticed a necrotic coccygeal ulceration (with rapid increasing dimensions 0.5/0.5 cm in 24 hours), and with the transformation from a dry necrosis in a sphacelus at the periphery and progression of necrosis in depth. DIAGNOSES: The patient was diagnosed with ecthyma gangrenosum from which Pseudomonsa aeruginosa and Enterococcus faecalis were isolated from the samples that were harvested intraoperatively, decision that was taken considering the appearance of CT scan and the extremely rapid expansion of necrosis. Excisional debridement with necrectomy, lavage, and dressing being performed. The invasion of the fascia was excluded intraoperatively. INTERVENTIONS: Treatment with Meropenem for 14 days was initiated, as well as amikacin and linezolid, the latter being replaced with teicoplanin for 14 days. Red blood cells transfusion, intravenous immunoglobulins, anticonvulsants were also administered. OUTCOMES: Under treatment the evolution was favorable. LESSONS: This case brings into discussion a double etiology of ecthyma gangrenosum, in a previously healthy child that occurred in the evolution of influenza. The evolution was favorable under broad-spectrum antibiotic treatment and surgical excision.

Ectima gangrenosa en un niño previamente sano / Gangrenous ecstasy in a previously healthy child

El ectima gangrenoso es una infección poco frecuente de la piel generalmente causada por Pseudomona aeruginosa, usualmente ocurre en pacientes inmunocomprometidos pero ocasionalmente afecta a individuos sanos. Debido a las complicaciones que el paciente puede presentar en el transcurso de la enfermedad, la mortalidad por la misma es alta, sobre todo en los pacientes con bacteriemia. Se describió el caso de un niño de 1 año, atendido por varias lesiones en piel y toma del estado general hasta la gravedad. Se realizó tratamiento multidisciplinario y se logró la evolución satisfactoria al egreso(AU)

Ecthymagangrenosum is a rare infection of the skin usually caused by Pseudomoma aeruginosa, usually occurs in immunocompromised patients but occasionally affects healthy individuals. Due to the complications that the patient may present during the course of the disease, the mortality is high, especially in patients with bacteremia. It was described a case of 1-year-old child, treated for several skin lesions and general conditions to the point of gravity that were taking into account. A multidisciplinary treatment was carried out and satisfactory evolution was achieved at discharge(AU)

Ecthyma gangrenosum of the scrotum: a case report.

A 43-year-old man with pancytopenia from chemotherapy for acute myeloid leukemia developed left scrotal pain, fever, and rigors. Physical exam revealed an ulcerating lesion with central necrosis and eschar surrounded by a halo of erythema on the inferior aspect of the left scrotum. The condition indicated an early necrotizing soft tissue infection. The patient was started on broad-spectrum antibiotics and taken to the operating room for a wound debridement. Blood and tissue cultures grew Pseudomonas aeruginosa, which confirmed the diagnosis of ecthyma gangrenosum of the scrotum. The fever resolved, and the wound healed without further progression after wet to dry dressing changes.

Nonpseudomonal ecthyma gangrenosum of the upper lid treated with lid reconstruction.

Ecthyma gangrenosum (EG) is a cutaneous infection which usually occurs in immunocompromised patients. We report a case of EG of the eyelid treated with escharotomy and skin grafting, highlighting the importance of surgical management. A 2-year-old Asian Indian female presented to us with right upper lid edema with a large necrotic area. The child received intravenous cefotaxime for a week and the necrotic area turned to a well-defined eschar. Escharotomy with wound debridement and skin grafting was done. The present case highlights the importance of surgical intervention to prevent the sequelae of scarring of upper lid.

Periorbital ecthyma gangrenosum: a case report and review of the literature.

Ecthyma gangrenosum is a cutaneous manifestation of a Pseudomonas aeruginosa infection that is extremely rare in the periorbital region. The authors present a 48-year-old woman with a newly diagnosed acute promyelocytic leukemia with necrosis of her bilateral upper and lower eyelids and the lacrimal system. Following treatment with intravenous antibiotic and surgical debridement with delayed reconstruction, the patient had healed well.

Pseudomonas aeruginosa sepsis with ecthyma gangrenosum and pseudomembranous pharyngolaryngitis in a 5-month-old boy.

Pseudomonas aeruginosa infection that induced pseudomembranous laryngopharyngitis and ecthyma gangrenosum simultaneously in a healthy infant is rare. We reported on a previously healthy 5-month-old boy with initial presentation of fever and diarrhea followed by stridor and progressive respiratory distress. P. aeruginosa sepsis was suspected because ecthyma gangrenosum over the right leg was found at the emergency department, and the diagnosis was confirmed by the blood culture. Fiberscope revealed bacterial pharyngolaryngitis without involvement of the trachea. Because of early recognition and adequate treatment, including antimicrobial therapy, noninvasive ventilation, incision, and drainage, he recovered completely without any complications.

Ectima gangrenoso facial en dos recién nacidos pretérmino / Facial Ecthyma Gangrenosum in 2 Preterm Neonates

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Acupuncture as add-on treatment in the management of a patient with ecthyma gangrenosum.

Acupuncture is believed to have a positive effect on wound healing. A case is presented in which the healing of a leg ulcer which proved to be difficult to treat coincided with the added treatment modality of needling healthy tissue surrounding the lesion. It raises questions about the potential effect of local dry needling on tissue regeneration.

Magnetoterapia en el dolor miofacial: presentación de casos / Magnet therapy in myofascial pain: presentation of cases

Fundamento: El cancrum oris es una rara patología en las últimas décadas, su etiología es infecciosa, afectando principalmente a niños desnutridos o con algún tipo de inmunodeficiencia; puede ser fácilmente confundida con tumores neoplásicos, ectima gangrenoso, lo que ocasiona errores de tratamiento con efectos indeseables severos. Presentación de caso: Se presenta un caso, comentándose el método diagnóstico, tratamiento médico y quirúrgico, con los que se obtuvo resultados muy favorables. Conclusiones: El diagnóstico certero, la combinación de medicamentos de amplio espectro y la intervención quirúrgica del área afectada, son la base del tratamiento, lográndose salvar la vida del paciente y la recuperación de la mayoría de los tejidos bucales y faciales más afectados(AU)

Background: Cancrum oris is a rare disease in recent decades. It has an infectious etiology and affects mainly malnourished children or those with some type of immunodeficiency. It can be easily confused with neoplastic tumors and ecthyma gangrenosum, which leads to errors of treatment with severe undesirable effects. Case presentation: A case is reported commenting on the diagnostic method, and the medical and surgical treatments, with which very favorable results were obtained. Conclusions: The accurate diagnosis, the combination of broad-spectrum drugs and surgery of the affected area are the basis of treatment. The patients life was saved and the majority of his buccal and facial tissues most severely affected were recovered(AU)

Ecthyma gangrenosum in a premature low-birth-weight newborn.

Ecthyma gangrenosum is a well-recognised cutaneous infection in critically ill and immunocompromised patients. It is commonly associated with Pseudomonas aeruginosa septicaemia. Classic lesions of ecthyma gangrenosum comprise deep ulcers with ecchymotic, gangrenous centres, bright red areolae and typical raised, purplish, indurated, rolled-out edges. We report ecthyma gangrenosum in a premature low-birth-weight neonate, delivered at home to a third gravida mother with history of chorioamnionitis. He was admitted to a private hospital on third day of life, with a diagnosis of early-onset neonatal sepsis and received multiple antibiotics over next 22 days. The infant was referred to the paediatrics emergency department of Sir Sunderlal Hospital, Banaras Hindu University in a condition of shock, pneumonitis and generalised sepsis. Two gangrenous ulcers with gray-black eschar were present, one over the neck and another over the back. He was diagnosed as a case of neonatal sepsis with ecthyma gangrenosum. Blood culture revealed growth of Pseudomonas aeruginosa, sensitive only to imipenem. The infant died the day following admission.

Successful treatment of Fusarium solani ecthyma gangrenosum in a patient affected by leukocyte adhesion deficiency type 1 with granulocytes transfusions.

BACKGROUND: Ecthyma gangrenosum (EG) manifests as a skin lesion affecting patients suffering extreme neutropenia and is commonly associated with Pseudomonas aeruginosa in immunocompromised patients. Leukocyte adhesion deficiency I (LAD I) which count among primary immunodeficiency syndromes of the innate immunity, is an autosomal recessive disorder characterized in its severe phenotype by a complete defect in CD18 expression on neutrophils, delayed cord separation, chronic skin ulcers mainly due to recurrent bacterial and fungal infections, leucocytosis with high numbers of circulating neutrophils and an accumulation of abnormally low number of neutrophils at sites of infection. CASE PRESENTATION: We report at our knowledge the first case of a child affected by LAD-1, who experienced during her disease course a multi-bacterial and fungal EG lesion caused by fusarium solani. Despite targeted antibiotics and anti-fungi therapy, the lesion extended for as long as 18 months and only massive granulocytes pockets transfusions in association with G-CSF had the capacity to cure this lesion. CONCLUSION: We propose that granulocytes pockets transfusions will be beneficial to heal EG especially in severely immunocompromised patients.

Ecthyma gangrenosum in a patient with toxic epidermal necrolysis.

Toxic epidermal necrolysis and Stevens-Johnson syndrome are a spectrum of disease characterized by a delayed hypersensitivity reaction that involves the skin and mucous membranes and typically is associated with either recent upper respiratory infection or with certain medications. Ecthyma gangrenosum is a rare necrotizing vasculitis that most commonly affects immunocompromised and burn patients and is often a sequela of Pseudomonas aeruginosa bacteremia. The cutaneous lesions of ecthyma gangrenosum are characterized by an erythematous halo surrounding a dark gray or black nodule. P. aeruginosa preferentially invades the venules, resulting in secondary thrombosis of the arterioles, tissue edema, and separation of the epidermis. Management of ecthyma gangrenosum includes systemic treatment with antipseudomonal antibiotics and débridment of the lesions, as well as improving the patient's immune status if possible. We present a case of a patient admitted to the burn unit for toxic epidermal necrolysis who developed pseudomonal bacteremia with ecthyma gangrenosum.

Ectima infeccioso bacteriémico en paciente con infección por virus de la inmudeficiencia humana / Infectious bacteremic ecthyma in a patient with HIV infection

El ectima es una piodermitis profunda ulcerativa causada habitualmente por estreptococo betahemolítico del grupo A (Streptococcus pyogenes). Suele presentarse en zonas de piel dañada y en pacientes inmunocomprometidos, y es muy infrecuente que se acompañe de sintomatología general y bacteriemia. Se describe el caso de una paciente de 41 años de edad con infección por virus de la inmunodeficiencia humana (VIH) que presentó fiebre y lesiones ulceradas en tobillo derecho y pie izquierdo de 3 semanas de evolución. En el cultivo de la biopsia cutánea y en los hemocultivos se aislaron simultáneamente S. pyogenes y Escherichia coli. La significación patogénica de E. coli en este caso es dudosa

Ecthyma is a deep ulcerative pyoderma usually caused by group A beta-hemolytic streptococcus (Streptococcus pyogenes). It usually presents in areas of damaged skin and in immunocompromised patients, and very infrequently is accompanied by general symptoms and bacteremia. We describe the case of a 41-year-old female patient with HIV infection who presented with fever and ulcerated lesions on the right ankle and left foot which had been developing for three weeks. Streptococcus pyogenes and Escherichia coli were simultaneously isolated from a culture of the skin biopsy sample and from blood cultures. Escherichia coli is of dubious pathogenic significance in this case

Common bacterial skin infections.

Skin infections account for a significant portion of dermatologic disease, often resulting in or as a consequence of a disruption in the skin's integrity. This article covers the presentation, diagnosis, and treatment of the more common bacterial infections. The infections presented herein include impetigo, ecthyma, folliculitis, carbuncles/furuncles, cellulitis, toxic shock syndrome, and ecthyma gangrenosum. Once a diagnosis is made, treatment is based on the culture and antibiotic sensitivities of the offending organisms.

Les infections cutanées et leur traitement / Skin infections and thweir treatment

Dans le cadre de cet article nous ne traiterons que les infections bactériennes et laisserons de côte les mycoses cutanées, parasitoses et viroses. Après un bref rappel clinique, nous évoquerons les remèmes homéopathiques et biothérapiques les plus efficaces dans chacune de ces affections. Nous distinguerons... (AU)

Bismuthum / Bismuthum

Dois pacientes portadores de quadros nosologicos distintos se beneficiaram com Bismuthum prescrito com base na conjuncao de sintomas caracteristicos e raros, de nivel mental e local