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

Trillig, Antonio Ulpiano; Deyi, Véronique Yvette Miendje; Youatou, Pierre; Konopnicki, Déborah

doi:10.1080/17843286.2019.1630570

Cited by 6 publications

(2 citation statements)

References 29 publications

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“…Although neutropenia is the most common risk factor for EG. 11 Viral diseases like measles have the ability to directly or indirectly inhibit bone marrow granulocytosis. Neutropenia can range greatly in severity, from moderate to severe.…”

Section: Discussionmentioning

confidence: 99%

An Infant with Measles Developed Ecthyma Gangrenosum Caused by Coagulase-Negative Staphylococcus: A Rare Case Report from Somalia

Ali,

Mohamed,

Hirsi

et al. 2023

IMCRJ

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Ecthyma gangrenosum is a skin lesion that can be caused by either bacterial hematogenous seeding or a primary skin infection. Despite being the most frequent causal agent, Pseudomonas aeruginosa is not the only bacteria that has been involved. Other types of bacteria may also be implicated in the etiology of EG: cocci bacteria, both gram-positive and gram-negative. Case Presentation: Here, we report the case of a 10-month-old male infant who developed ecthyma gangrenosum after a measles infection. At the time of admission, the patient had a high fever of about 40.3°C and appeared conscious. Physical examination revealed several skin lesions that were in various stages of development and appeared as nodules with a central crust and round, ulcerated, necrotic papules in the face, chest, and upper extremities. Laboratory tests showed CRP of 25 mg/l, LDH of 579 U/L, WBC of 15.06 × 1000/mm3, and absolute neutrophils of 1930/mm3 (12.8%). The result of the culture showed coagulase-negative Staphylococcus. According to the drug susceptibility test results, intravenous Vancomycin (20 mg/kg per dose, 3 times daily) should be started. A coagulase-negative Staphylococcus was eliminated as a result of this defervescence. The necrotic lesion was surgically removed from the patient. Clinical Discussion: Ecthyma gangrenosum is the all-over-the-body cutaneous manifestation of pseudomonas infection in sepsis patients. Patients who suffer from severe illnesses. Immune deficiencies commonly increase the chance of acquiring EG. Our patient had a history of measles, which led to neutropenia before developing EG. The management of ecthyma gangrenosum requires early identification and antimicrobial treatment. Conclusion:We describe a measles patient who developed coagulase-negative Staphylococcus ecthyma gangrenosum and had good results from both surgical debridement and systemic antibiotics. Our case serves as an example of the uncommon presentation of ecthyma gangrenosum. This example emphasizes the value of an early diagnosis and vigorous antimicrobial therapy in cases where ecthyma gangrenosum is clinically suspected.

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Section: Discussionmentioning

confidence: 99%

An Infant with Measles Developed Ecthyma Gangrenosum Caused by Coagulase-Negative Staphylococcus: A Rare Case Report from Somalia

Ali,

Mohamed,

Hirsi

et al. 2023

IMCRJ

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“…Hematological malignancies Turnbull and Parry [5] (1981) 68 M Erythroleukemia MSSA + + + Oxacillin sodium: 4 wk − Turnbull and Parry [5] (1981) 59 M Waldenström's macroglobulinemia MSSA − + NA Oxacillin: duration unclear − Chang et al [6] (2012) 35 F ALL MRSA − + + Vancomycin: duration unclear − Dassan et al [7] [10] (2012) 8 mo F No comorbidities MRSA − + − Vancomycin: 21 d − Apstolova [11] (2012) 59 M FVL mutation MRSA − + − Antimicrobials and surgical debridement: type of regimen and duration unclear − Ungprasert et al [12] (2013) 40 M HIV MRSA − + − Vancomycin: 10 d; linezolid PO: 1 mo − Song et al [13] (2015) 15 mo F No comorbidities MSSA − + − Ceftriaxone → cefepime and clindamycin: 14 d − Ivanaviciene [14] (2016) 54 F Gastric adenocarcinoma MSSA − + + Acyclovir, meropenem, vancomycin → intravenous oxacillin: 2 wk − Santhaseelan and Muralidhar [15] (2017) 47 M Chronic alcoholic MRSA − + − Ceftriaxone → imipenem and amikacin with surgical debridement: duration unclear − Ulpiano Trillig et al [16] (2019) 27 M No comorbidities S. aureus, GAS − + − Antimicrobial therapy: 7 d − Ulpiano Trillig et al [16] (2019) 31 M HIV S. aureus, GAS − + − Antimicrobial therapy with surgical debridement: 14 d − Barry et al [17] (2021) 19 M CKD MRSA − + − Linezolid without surgical debridement: 4 wk − Shah et al [18] blood cultures returned positive. In the previous reports, 44% (74/167) of EG (any pathogen) was associated with positive blood culture results, while only 9% (4/44) of nonpseudomonal EG was associated with positive blood culture results.…”

Section: In-hospital Deathmentioning

confidence: 99%

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

et al. 2022

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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 methicillinsensitive 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.

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HIV and the Skin

Bunker,

Piguet

2024

Rook's Textbook of Dermatology

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Within 2 years of defining acquired immune deficiency syndrome (AIDS) as a distinctive syndrome in 1981, human immunodeficiency virus (HIV) was identified as the causative agent. Dermatological involvement in AIDS has been appreciated since the disease was first recognised. Mucocutaneous involvement establishes criteria for diagnosis and staging; the prognostic significance of some complications, for example pruritic papular eruption/eosinophilic folliculitis, hairy leukoplakia and Kaposi sarcoma (KS), was well recognised before specific treatments were introduced. The proportion of patients with skin complications and the number of these manifestations in any one patient increase as HIV infection progresses and AIDS develops. The incidence and severity of several common cutaneous diseases (such as mollusca, herpes simplex and seborrhoeic dermatitis) are increased in patients with HIV and this correlates in many instances with the absolute numbers of CD4+ T cells. The effect HIV infection may have on some dermatological conditions such as psoriasis and leprosy is less clear‐cut. The advent of highly active combined antiretroviral therapy (ART) has been incalculably beneficial to patients with HIV, but novel side effects of these drugs (such as lipodystrophy) have emerged, and the skin can be affected by manifestations of the immune reconstitution inflammatory syndrome/immune reconstitution associated disease. The dermatological complications of HIV and AIDS may be distressing to patients and difficult for dermatologists to diagnose and manage. Also, many dermatoses presenting in the population at large need to be regarded as ‘indicator conditions’ to prompt advice about, and initiation of, HIV testing.

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

Cited by 6 publications

References 29 publications

An Infant with Measles Developed Ecthyma Gangrenosum Caused by Coagulase-Negative Staphylococcus: A Rare Case Report from Somalia

An Infant with Measles Developed Ecthyma Gangrenosum Caused by Coagulase-Negative Staphylococcus: A Rare Case Report from Somalia

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

HIV and the Skin

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