Ectima gangrenoso por Pseudomona aeuginosa / Ecthyma gangrenosum due to Pseudomonas aeruginosa

El ectima gangrenoso es una manifestación dermatológica característica de una infección severa causada casi siempre por Pseudomonas aeruginosa (P. aeruginosa), con o sin bacteriemia. Las infecciones severas por P. aeruginosa se presentan habitualmente en pacientes con inmunodepresión u hospitalizados, en los pacientes sanos existe el antecedente de foliculitis y forunculosis. El diagnóstico es evidentemente clínico con confirmación en cultivos. El ectima es una manifestación cutánea de una infección severa que lleva a confusión diagnóstica y causa retraso en el inicio del tratamiento. El tratamiento quirúrgico precoz asociado a una cobertura antibiótica amplia y a un soporte metabólico y nutricional adecuados son la primera elección terapéutica. Se presenta el caso de una paciente joven inmunocompetente que presentó un shock séptico asociado a neutropenia, ectima gangrenoso e infección de vías urinarias causado por P. aeruginosa

Ecthyma gangrenosum is a dermatological manifestation characteristic of a severe infection almost always caused by P. aeruginosa, with or without bacteraemia. Severe infections by P. aeruginosa usually present in immunocompromised or hospitalised patients, or in healthy patients with a history of folliculitis and furunculosis. The diagnosis is clinical with culture confirmation. Ecthyma is a cutaneous manifestation of a severe infection that leads to misdiagnosis and delayed treatment. Early surgical treatment associated with a broad antibiotic coverage and adequate metabolic and nutritional support are the first therapeutic choice. We describe the case of a young immunocompetent patient who presented septic shock associated with neutropenia, ecthyma gangrenosum and urinary tract infection caused by P. aeruginosa

Unusual presentation of human giant orf (ecthyma contagiosum).

Giant orf is a zoonotic infection that is endemic in sheep and goats. It may be transmitted to humans by direct contact with infected animals or contaminated objects and is typically found on the hands. We report the case of a sheep farmer with facial orf that proliferated dramatically with the formation of satellite lesions after curettage.

Two giant orf lesions in a heart/lung transplant patient.

Orf is an infectious ulcerative stomatitis of sheep and goats. The responsible pathogen, parapoxvirus, may be transmitted to humans. Orf lesions are often atypical in immunocompromised individuals. The present report describes two very large exophytic lesions in a 31-year-old transplant patient receiving oral tacrolimus, mycophenolate mofetil and prednisone. Early surgical excision was successful, with no relapse after 14 months.

[Stay away from surgery: ecthyma contagiosum]. / Operation kontraindiziert: Das Ecthyma contagiosum (Orf) an der Hand.

15 patients with Orf's disease were evaluated. Seven out of 15 patients (Group 1) were treated surgically because of different diagnoses. Seven patients who were misdiagnosed and treated surgically (Group 1), and eight patients (Group 2) were followed conservatively. The aim of this study is to compare the treatment period of the misdiagnosed surgically treated (Group 1) group and conservatively treated group (Group 2). Lesions were aggravated and delayed healing was observed in Group 1. Diagnosis of Orf disease may sometimes be difficult because of concominant bacterial superinfections and surgical trauma. Careful history and clinical findings point to the correct diagnosis. Contrary to other infections of the hand, surgery can cause further complications in this disease. Conservative treatment is the gold standard, even in complicated cases.

Recurrent contagious ecthyma (Orf) in an immunocompromised host successfully treated with cryotherapy.

A 48-year-old patient under immunosuppressive therapy for renal transplantation had contagious ecthyma which relapsed after excision. Stable healing was obtained by cryotherapy.

Recurrent orf in an immunocompromised host.

A 30-year-old farmer with Nezelof's syndrome developed a giant orf on his hand. Recurrence followed surgical excision. Three excisions and split skin grafts were required before its eradication. He re-presented 8 years later with a further orf on the finger of his opposite hand. This lesion had not grown to the exuberant proportion of the previous lesion, but it defied repeated excisions, and various medical therapies including idoxuridine, interferon and transfer factor. Excision with hypochlorite dressings perioperatively and delayed split skin grafting led to eventual eradication.