RESUMO
A 51-year-old male with profound and prolonged neutropenia 12 days after receiving chemotherapy for an acute myeloid leukemia developed a nodular, erythematous lesion with a necrotic center on the base of the neck, associated with fever, chills, and myalgia. An invasive fungal infection was diagnosed after growth of Candia tropicalis in blood cultures. He evolved with multiple reddish papular lesions concentrated mainly on the trunk, although they also spread to the extremities. The most common skin lesions of disseminated candidiasis are erythematous-violaceous papules with vesicular centers, which, in some cases, can progress to necrosis. Other forms of cutaneous presentation of invasive candidiasis are ecthyma gangrenosum-like lesions, hemorrhagic plaques or bullae, rash resembling folliculitis, and subcutaneous nodules.
Un varón de 51 años que se encontraba con neutropenia profunda y prolongada luego de 12 días del inicio de su quimioterapia por una leucemia mieloide aguda desarrolló una lesión nodular, eritematosa y con centro necrótico en la base del cuello, asociada a fiebre, escalofríos y mialgias. Se diagnosticó infección fúngica invasiva luego del desarrollo de Candia tropicalis en los hemocultivos. Evolucionó con múltiples lesiones papulares rojizas concentradas principalmente en el tronco, aunque también extendidas a las extremidades. Las lesiones cutáneas más frecuentes de la candidiasis diseminada son pápulas eritematosas-violáceas con centros vesiculares, que, en algunos casos, pueden evolucionar a necrosis. Otras formas de presentación cutánea de la candidiasis invasiva son lesiones similares a ectima gangrenoso, placas o bullas hemorrágicas, erupción que resembla foliculitis, y nódulos subcutáneos.
Assuntos
Candidíase Invasiva , Ectima , Leucemia Mieloide Aguda , Masculino , Humanos , Pessoa de Meia-Idade , Pele/patologia , Candidíase Invasiva/complicações , Candidíase Invasiva/patologia , Ectima/complicações , Ectima/patologia , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/tratamento farmacológicoRESUMO
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.
Assuntos
Ectima/diagnóstico , Ectima/tratamento farmacológico , Hematologia/métodos , Neoplasias/complicações , Adolescente , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Criança , Pré-Escolar , Ectima/complicações , Ectima/microbiologia , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/tratamento farmacológico , Feminino , Humanos , Lactente , Itália , Masculino , Recidiva Local de Neoplasia/complicações , Neutropenia/complicações , Infecções por Pseudomonas , Pseudomonas aeruginosa/isolamento & purificação , Estudos Retrospectivos , Stenotrophomonas maltophilia/isolamento & purificaçãoAssuntos
Ectima/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa , Criança , Ectima/complicações , Feminino , Humanos , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Infecções por Pseudomonas/complicaçõesRESUMO
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 0.5/0.5âcm in 24âhours), 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.
Assuntos
Ectima/complicações , Infecções por Bactérias Gram-Positivas/complicações , Hospedeiro Imunocomprometido , Influenza Humana/complicações , Infecções por Pseudomonas/complicações , Antibacterianos/uso terapêutico , Desbridamento/métodos , Ectima/terapia , Enterococcus faecalis , Feminino , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Lactente , Influenza Humana/terapia , Meropeném/uso terapêutico , Infecções por Pseudomonas/terapia , Pseudomonas aeruginosa , Sepse/microbiologiaRESUMO
Platelet rich fibrin (PRF) gel is a new second generation platelet concentrate, which has been widely used in various dermatological conditions such as nonhealing diabetic foot ulcers, venous ulcers, and trophic ulcers in leprosy. In this case report, we present a patient with nonhealing ulcer secondary to ecthyma gangrenosum, who showed dramatic response with PRF gel. This case suggests a role of PRF gel in nonhealing ulcers of infectious etiology which has not been described in English language literature. Considering previous literature and our case, it may be concluded that PRF gel may be utilized as an effective alternative for nonhealing ulcers of nonneoplastic etiology.
Assuntos
Ectima/complicações , Fibrina Rica em Plaquetas , Úlcera Cutânea/terapia , Feminino , Géis , Humanos , Pessoa de Meia-IdadeAssuntos
Ectima/complicações , Pneumonia Associada a Assistência à Saúde/complicações , Infecções por Pseudomonas/complicações , Choque Séptico/etiologia , Infecções Comunitárias Adquiridas/complicações , Ectima/diagnóstico , Ectima/microbiologia , Feminino , Humanos , Hidroterapia/efeitos adversos , Pessoa de Meia-Idade , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/isolamento & purificaçãoAssuntos
Ectima/diagnóstico , Hemoglobinúria Paroxística/diagnóstico , Antibacterianos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Ciprofloxacina/uso terapêutico , Ectima/complicações , Ectima/tratamento farmacológico , Feminino , Hemoglobinúria Paroxística/complicações , Hemoglobinúria Paroxística/tratamento farmacológico , Hemoglobinúria Paroxística/patologia , Humanos , Pessoa de Meia-Idade , Necrose , Pseudomonas aeruginosa/isolamento & purificação , Pele/microbiologia , Pele/patologiaAssuntos
Ectima/complicações , Dermatoses Faciais/complicações , Infecções Oportunistas/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Infecções por Pseudomonas/complicações , Adolescente , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Quimioterapia Combinada , Diagnóstico Precoce , Ectima/diagnóstico , Ectima/tratamento farmacológico , Edema/microbiologia , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/tratamento farmacológico , Feminino , Humanos , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosaRESUMO
No disponible
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Ectima/complicações , Transplante de Rim , Antibacterianos/uso terapêutico , Imunossupressores/uso terapêutico , Transtornos de Deglutição/diagnóstico , Gangrena/etiologiaRESUMO
BACKGROUND: Ecthyma gangrenosum is an acute ulcer necrotic skin infection frequently caused by Pseudomonas aeruginosa. It is characterised by necrotic ulcerations circumscribed by an inflammatory halo. Lesions are normally found in the anal, genital and axillary regions. Ecthyma gangrenosum is most commonly seen in immunodepressed patients (cytotoxic chemotherapy, HIV infection, neutropenia or functional neutrophil deficiency, agammaglobulinemia). It is a rarely described complication in chicken pox. PATIENTS AND METHODS: Herein we report the case of a girl aged 2 ½ years presenting in our dermatology department with ecthyma gangrenosum on the right upper eyelid secondary to varicella. The disease course was marked by fibrous scarring of the inner canthus with ptosis of the right upper eyelid. The retractile scarring caused disability. DISCUSSION: There have been previous reports of the contribution of non-steroidal anti- inflammatory drugs (NSAIDs) to the appearance of necrotic cutaneous super infections during the course of chickenpox. The occurrence of such complications on an eyelid may be harmful not only for the function of the eye but it can also cause extensive aesthetic impairment. Subsequent aesthetic and functional impairment may be improved by corrective surgery.
Assuntos
Varicela/complicações , Ectima/complicações , Doenças Palpebrais/microbiologia , Infecções por Pseudomonas/complicações , Blefaroptose/etiologia , Pré-Escolar , Feminino , Humanos , Pseudomonas aeruginosa/isolamento & purificaçãoRESUMO
No disponible
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Infecções/tratamento farmacológico , Úlcera/complicações , Úlcera/tratamento farmacológico , Amoxicilina/uso terapêutico , Leucocitose/complicações , Leucocitose/diagnóstico , Leucocitose/tratamento farmacológico , Levofloxacino/uso terapêutico , Ectima/complicações , Ectima/tratamento farmacológico , Esplenectomia/métodos , Mãos , Doença de Mão, Pé e Boca/complicações , Doença de Mão, Pé e Boca/tratamento farmacológico , Biópsia/métodos , Pseudomonas aeruginosa , Pseudomonas aeruginosa/isolamento & purificaçãoRESUMO
BACKGROUND: Ecthyma gangrenosum (EG) is an anatomoclinical syndrome commonly associated with Pseudomonas aeruginosa cutaneous infection. Other microorganisms have also been incriminated on occasion, with other viral, fungal and bacterial agents potentially causing EG. In this report, we present an extremely rare case of an EG caused by methicillin-sensitive Staphylococcus aureus (MSSA) infection. This case, highly characteristic of EG both clinically and histologically, calls into question the physiopathological mechanisms of the disease and provides a reminder that it may be caused by a variety of organisms. PATIENTS AND METHODS: A 62-year-old woman, followed for HIV seropositivity at the AIDS stage, developed a painful purpuric skin rash evolving towards necrotic nodules characteristic of ecthyma gangrenosum. Skin biopsy confirmed the diagnosis of EG due to methicillin-sensitive S. aureus (MSSA) infection without toxins or bacteraemia. DISCUSSION: To the best of our knowledge, this is the first case in the literature in which MSSA is reported as the underlying cause of such lesions.
Assuntos
Ectima/microbiologia , Meticilina/farmacologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Toxinas Bacterianas/análise , Sangue/microbiologia , Confusão/etiologia , Ectima/complicações , Ectima/diagnóstico , Ectima/tratamento farmacológico , Ectima/patologia , Exotoxinas/análise , Reações Falso-Negativas , Feminino , Infecções por HIV/complicações , Humanos , Leucocidinas/análise , Resistência a Meticilina , Pessoa de Meia-Idade , Pele/patologia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/patologia , Staphylococcus aureus/química , Staphylococcus aureus/efeitos dos fármacosRESUMO
BACKGROUND: Ecthyma gangrenosum (EG) involving the external ear canal is an unusual presentation. OBJECTIVE: To describe a case of EG diagnosed in a 5-day-old female who was admitted to our institute with multiple soft-tissue lesions involving the right arm, forearm, back, and perineum and with a complete facial palsy associated with ipsilateral external otitis. RESULTS: The patient presented neonatal sepsis associated with significant leucopenia, thrombocytopenia and alteration of the coagulation profile. Microbiological analysis was performed on the purulent otorrhea and on the exudate material collected at the level of the genital lesion; both of these specimens tested positive for the presence of Pseudomonas aeruginosa. An intravenous antibiotic treatment was administered and a rapid improvement from the infection was observed. CONCLUSION: The rare occurrence of this presentation, combined with the potential for fatal complications from EG if not swiftly diagnosed underline the importance of this case.
Assuntos
Ectima/complicações , Doenças do Nervo Facial/complicações , Otite Externa/etiologia , Sepse/complicações , Feminino , Humanos , Recém-Nascido , Períneo/microbiologia , Períneo/patologia , Infecções por Pseudomonas/complicações , Pseudomonas aeruginosa , Úlcera Cutânea/microbiologiaRESUMO
A 35-year-old woman with postoperative recurrent Graves' disease presented with a 5-day history of a red swelling on the right cheek associated with 4 days of remittent hyperpyrexia. Investigations revealed fever, a gangrenous ulcer on the right cheek, submandibular lymphadenopathy, and thyroid gland enlargement. Her white blood cell count, immunoglobulins, and lymphocyte subsets were unremarkable. Thyroid function tests showed low thyroid-stimulating hormone, high free thyroxine, and elevated radioactive iodine uptake. Repeated pus cultures grew Pseudomonas aeruginosa, but blood cultures were negative. An ill-demarcated erythematous plaque occurred on the right leg on hospital day 3. She was treated with intravenous antibiotics with topical gentamicin, recombinant bovine basic fibroblast growth factor, and radioiodine therapy with anti-thyroid drugs. The ulcer healed leaving a depressed scar at 35 days after discharge. This patient may represent the first case of P. aeruginosa ecthyma gangrenosum and cellulitis in postoperative recurrent Graves' disease.
Assuntos
Celulite (Flegmão)/complicações , Ectima/complicações , Doença de Graves/complicações , Infecções por Pseudomonas/complicações , Adulto , Celulite (Flegmão)/metabolismo , Celulite (Flegmão)/microbiologia , Celulite (Flegmão)/patologia , Ectima/metabolismo , Ectima/microbiologia , Ectima/patologia , Feminino , Doença de Graves/metabolismo , Doença de Graves/microbiologia , Doença de Graves/patologia , Humanos , Infecções por Pseudomonas/metabolismo , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/patologia , Pseudomonas aeruginosa/patogenicidade , Pseudomonas aeruginosa/fisiologia , RecidivaRESUMO
No disponible
Assuntos
Humanos , Feminino , Recém-Nascido , Ectima/complicações , Ectima/diagnóstico , Ectima/embriologia , Ectima/prevenção & controle , Ectima/terapia , Dermatopatias , Trabalho de Parto Prematuro , Neutropenia , Sepse , Pseudomonas aeruginosa , Relatos de CasosAssuntos
Ectima/diagnóstico , Leucemia Linfocítica Crônica de Células B/complicações , Infecções por Pseudomonas/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Ectima/complicações , Ectima/tratamento farmacológico , Evolução Fatal , Humanos , Masculino , Necrose , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa , Sepse/complicações , Sepse/tratamento farmacológico , Sepse/microbiologia , Vasculite/complicaçõesRESUMO
Ecthyma gangrenosum is a rare necrotizing cutaneous infection usually caused by Pseudomonas aeruginosa. We report a case of ecthyma gangrenosum presenting as a sinonasal eschar and mimicking acute invasive fungal sinusitis in an immunocompromised 39-year-old man with a hematologic malignancy. To the best of our knowledge, this represents the first case of ecthyma gangrenosum affecting the sinonasal mucosa to be reported in the literature.
Assuntos
Ectima/complicações , Hospedeiro Imunocomprometido , Mucosa Nasal/microbiologia , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa , Sinusite/diagnóstico , Acetamidas/uso terapêutico , Adulto , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Ectima/diagnóstico , Ectima/tratamento farmacológico , Humanos , Linezolida , Masculino , Micoses/diagnóstico , Micoses/microbiologia , Mucosa Nasal/patologia , Mucosa Nasal/cirurgia , Ofloxacino/uso terapêutico , Oxazolidinonas/uso terapêutico , Inibidores da Síntese de Proteínas/uso terapêutico , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Pioderma Gangrenoso , Fatores de Risco , Sinusite/microbiologia , Vancomicina/uso terapêuticoRESUMO
BACKGROUND: Ecthyma is an invasive, ulcerated skin infection. Four ecthyma outbreaks occurred in different infantry units in the Israeli Defense Force from October 2004 through February 2005. Morbidity attack rates in the first 3 outbreaks were 89% (49 of 55 soldiers), 73% (32 of 44), and 82% (37 of 45). In the fourth outbreak, in which early intervention (antimicrobial treatment and improvement of hygiene) was applied, the attack rate was 25% (10 of 40 soldiers). In the first outbreak cluster, 4 soldiers experienced poststreptococcal glomerulonephritis, and 5 cases of systemic sequelae were recorded (1 case of severe septic shock, 3 cases of pneumonia, and 1 case of septic olecranon bursitis). METHODS: Streptococcus pyogenes and Staphylococcus aureus were isolated from ecthyma sores, oropharynx, and anterior nares of affected and unaffected soldiers involved in all 4 outbreaks. RESULTS: Although the S. aureus isolates had different genomic profiles, >90% of S. pyogenes isolates were identified as belonging to a single clone, emm type 81, T type 8. Epidemiological investigation revealed that the hygiene levels of the soldiers and their living conditions were probably the most important cause for the difference in attack rates, wound severity, and systemic sequelae found between and within the units. CONCLUSIONS: Our study demonstrates the possible ramifications of the combination of a virulent and highly infective S. pyogenes strain and poor living conditions, and it emphasizes the importance of early intervention in such conditions.