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1.
Am J Case Rep ; 20: 1369-1372, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31523051

RESUMO

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.


Assuntos
Ectima/microbiologia , Neutropenia Febril/etiologia , Infecções por Pseudomonas/diagnóstico , Escroto/microbiologia , Idoso , Humanos , Hospedeiro Imunocomprometido , Leucemia Mieloide Aguda/complicações , Masculino , Pseudomonas aeruginosa/isolamento & purificação
2.
Transpl Infect Dis ; 21(4): e13131, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31216602

RESUMO

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.


Assuntos
Ectima/diagnóstico , Transplante de Coração/efeitos adversos , Infecções por Pseudomonas/diagnóstico , Antibacterianos/uso terapêutico , Pré-Escolar , Desbridamento , Ectima/tratamento farmacológico , Ectima/microbiologia , Ectima/cirurgia , Humanos , Hospedeiro Imunocomprometido , Masculino , Infecções por Pseudomonas/tratamento farmacológico
4.
J Eur Acad Dermatol Venereol ; 33(4): 781-785, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30633375

RESUMO

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.


Assuntos
Ectima/microbiologia , Gangrena/microbiologia , Neutropenia/tratamento farmacológico , Infecções por Pseudomonas/complicações , Pseudomonas aeruginosa , Doenças da Vulva/microbiologia , Antibacterianos/uso terapêutico , Feminino , Gentamicinas/uso terapêutico , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Humanos , Lactente , Neutropenia/complicações , Infecções por Pseudomonas/tratamento farmacológico
5.
BMC Infect Dis ; 19(1): 85, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30683071

RESUMO

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.


Assuntos
Ectima/diagnóstico , Leucemia de Células Pilosas/diagnóstico , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa , Antibacterianos/uso terapêutico , Ectima/microbiologia , Febre/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/tratamento farmacológico
9.
Pan Afr Med J ; 30: 95, 2018.
Artigo em Francês | MEDLINE | ID: mdl-30344879

RESUMO

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.


Assuntos
Ectima/diagnóstico , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/isolamento & purificação , Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Pré-Escolar , Diagnóstico Diferencial , Ectima/tratamento farmacológico , Ectima/microbiologia , Humanos , Masculino , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Resultado do Tratamento
11.
J Pediatr Adolesc Gynecol ; 31(6): 625-628, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29885367

RESUMO

BACKGROUND: An 18-month-old female toddler presented with severe vulvar ulcers and pancytopenia with investigations revealing Pseudomonas aeruginosa bacteremia. CASE: A previously healthy 18-month-old female toddler presented with 6 days of fevers, vulvar rash, and ulcers. Vulvar cultures showed Staphylococcus aureus and P aeruginosa. Bloodwork showed pancytopenia and P aeruginosa bacteremia. She started receiving broad-spectrum antibiotics. Bone marrow aspirate revealed a hypocellular marrow with erythroid dysplasia. Vulvar ulcers progressed rapidly, therefore magnetic resonance imaging was performed to rule out necrotizing fasciitis. She was diagnosed with ecthyma gangrenosum (EG). Three months after initial presentation, she was diagnosed with precursor B-cell acute lymphoblastic leukemia. SUMMARY AND CONCLUSION: This case highlights that health care providers should suspect EG when severe vulvar ulcers are present with P aeruginosa infection and neutropenia. Because EG poses significant morbidity and mortality, its presence should prompt aggressive antimicrobial therapy and mobilization of a multidisciplinary team to initiate workup for an underlying immunodeficiency syndrome or malignancy. This case also illustrates that surgical debridement might be avoided in certain patients with EG as long as meticulous wound care and close monitoring with a multidisciplinary team are in place.


Assuntos
Ectima/microbiologia , Pseudomonas aeruginosa , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus , Doenças da Vulva/microbiologia , Antibacterianos/uso terapêutico , Ectima/tratamento farmacológico , Feminino , Febre/microbiologia , Humanos , Lactente , Pancitopenia/tratamento farmacológico , Pancitopenia/microbiologia , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Úlcera/tratamento farmacológico , Úlcera/microbiologia , Doenças da Vulva/tratamento farmacológico
14.
An Bras Dermatol ; 92(5): 698-700, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29166510

RESUMO

Ecthyma gangrenosum is a rare skin infection classically associated with Pseudomonas aeruginosa. We performed a retrospective study of all cases diagnosed with ecthyma gangrenosum from 2004-2010 in a university hospital in Mexico (8 cases, 5 female patients and 3 male patients, ages between 4 months and 2 years). The most common risk factor for ecthyma gangrenosum is neutropenia in immunocompromised patients. In previously healthy patients, immunological evaluation is important to rule out underlying immunodeficiency. Ecthyma gangrenosum in healthy patients has a high mortality rate and early diagnosis and aggressive antibiotic treatment is imperative as it can improve patients' prognosis.


Assuntos
Ectima/microbiologia , Gangrena/microbiologia , Infecções por Pseudomonas/complicações , Pseudomonas aeruginosa/isolamento & purificação , Pré-Escolar , Ectima/tratamento farmacológico , Feminino , Gangrena/tratamento farmacológico , Humanos , Lactente , Masculino , Estudos Retrospectivos
15.
An. bras. dermatol ; 92(5): 698-700, Sept.-Oct. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-887040

RESUMO

Abstract: Ecthyma gangrenosum is a rare skin infection classically associated with Pseudomonas aeruginosa. We performed a retrospective study of all cases diagnosed with ecthyma gangrenosum from 2004-2010 in a university hospital in Mexico (8 cases, 5 female patients and 3 male patients, ages between 4 months and 2 years). The most common risk factor for ecthyma gangrenosum is neutropenia in immunocompromised patients. In previously healthy patients, immunological evaluation is important to rule out underlying immunodeficiency. Ecthyma gangrenosum in healthy patients has a high mortality rate and early diagnosis and aggressive antibiotic treatment is imperative as it can improve patients' prognosis.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Pseudomonas aeruginosa/isolamento & purificação , Infecções por Pseudomonas/complicações , Ectima/microbiologia , Gangrena/microbiologia , Estudos Retrospectivos , Ectima/tratamento farmacológico , Gangrena/tratamento farmacológico
16.
BMJ Case Rep ; 20172017 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-28775089

RESUMO

We report for the first time a case of non-pseudomonal ecthyma gangrenosum (EG) caused by methicillin-resistant Staphylococcus aureus in a chronic alcoholic without an associated immunocompromised state or disease. EG is an infection of the skin, commonly associated with Pseudomonas aeruginosa bacteraemia, though other organisms are also known to be causally related. It usually occurs in patients who are terminally ill and the immunocompromised. In our case, chronic alcoholism with suppression of innate immunity may have led to the development of the condition.


Assuntos
Alcoolismo/microbiologia , Ectima/microbiologia , Staphylococcus aureus Resistente à Meticilina , Pioderma Gangrenoso/microbiologia , Infecções Estafilocócicas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Pele/microbiologia , Infecções Estafilocócicas/microbiologia , Coxa da Perna/microbiologia
17.
BMJ Case Rep ; 20172017 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-28751433

RESUMO

A 55-year-old man undergoing chemotherapy for recurrent multiple myeloma presented with a 2-day history of bilateral lower leg rash with pain and oedema. On examination, there were numerous non-palpable retiform pruritic patches over both lower legs. Skin pnch biopsy demonstrated a diffuse interstitial neutrophilic infiltrate with necrosis. Peripheral blood and skin tissue cultures both isolated Citrobacterfreundii, consistent with a rare form of ecthyma gangrenosum. The patient responded with appropriate antibiotic therapy and removal of medical port. He made a full recovery from this infectious complication of his underlying immunosuppression.


Assuntos
Antibacterianos/administração & dosagem , Citrobacter freundii/efeitos dos fármacos , Ectima/microbiologia , Infecções por Enterobacteriaceae/microbiologia , Extremidade Inferior/microbiologia , Mieloma Múltiplo/tratamento farmacológico , Tienamicinas/administração & dosagem , Desbridamento , Ectima/tratamento farmacológico , Ectima/imunologia , Infecções por Enterobacteriaceae/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , Masculino , Meropeném , Pessoa de Meia-Idade , Mieloma Múltiplo/imunologia , Doenças Raras , Resultado do Tratamento
18.
Dermatol Online J ; 23(4)2017 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-28541874

RESUMO

Necrotizing fasciitis is a serious infection of the skin and soft tissues. Pasteurella multocida is rarely reported to cause necrotizing fasciitis and is associated with high mortality. We describe a female patient with a past medical history of diabetes mellitus and myeloproliferative disorder presenting with bullae and erythema of the right forearm secondary to P. multocida infection after possible cat bite. Despite adequate antibiotic coverage she developed necrotizing fasciitis diagnosed clinically and on diagnostic imaging. Patient was taken to the operating room emergently and underwent irrigation and debridement with subsequent split-skin graft. She recovered well after the surgeries and was discharge on intravenous antibiotics. At clinic follow-up, her wounds were healing well without any significant new symptoms.


Assuntos
Ectima/microbiologia , Fasciite Necrosante/microbiologia , Infecções por Pasteurella/complicações , Pasteurella multocida , Idoso , Antibacterianos/uso terapêutico , Desbridamento , Fasciite Necrosante/terapia , Feminino , Humanos , Síndromes Mielodisplásicas/complicações , Infecções por Pasteurella/tratamento farmacológico
19.
Medicine (Baltimore) ; 96(2): e5507, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28079790

RESUMO

RATIONALE: Ecthyma gangrenosum (Eg) is a necrotic lesion that is mostly seen in immunocompromised patients. It reflects a severe sepsis, possibly caused by Pseudomonas aeruginosa (Pa). PATIENT CONCERNS: A healthy 3-year-old girl admitted to the Pediatric Emergency Department presented a sepsis-associated purpura with neurological and respiratory distress. INTERVENTIONS: An empiric antibiotherapy (anti-meningococcal) was prescribed. DIAGNOSES: Forty-eight hours after admission, blood and wound cultures were positive for Pa. As a result, the decision was made to change the antibiotic therapy.Unfortunately, on day 3, the patient died. Exhaustive immunologic tests are presently being carried out. OUTCOMES: Eg caused by Pa is uncommon in healthy children, and purpura sepsis is usually caused by Neisseria meningitides infection. LESSONS: Eg should be recognized rapidly so that the appropriate treatment can be prescribed as quickly as possible.


Assuntos
Ectima/microbiologia , Infecções por Pseudomonas/complicações , Pseudomonas aeruginosa/isolamento & purificação , Sepse/microbiologia , Pré-Escolar , Evolução Fatal , Feminino , Humanos
20.
An. bras. dermatol ; 91(6): 815-816, Nov.-Dec. 2016. graf
Artigo em Inglês | LILACS | ID: biblio-837971

RESUMO

Abstract Ecthyma gangrenosum is an uncommon dermatological manifestation characterized by round, indurated ulcers with a central necrotic black eschar and surrounding erythema. This report describes the case of a 5-year-old girl, affected by acute lymphocytic leukemia, presenting with a black eschar on her right thigh. Such lesions should always be correctly identified to avoid potentially fatal bacteraemia. Furthermore, because of its similar clinical presentation, cutaneous anthrax must be ruled out.


Assuntos
Humanos , Feminino , Pré-Escolar , Infecções por Pseudomonas/microbiologia , Úlcera Cutânea/microbiologia , Ectima/microbiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Pseudomonas aeruginosa , Infecções por Pseudomonas/patologia , Úlcera Cutânea/patologia , Ectima/patologia
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