Ecthyma Gangrenosum: A Rare Cutaneous Manifestation of a Potentially Fatal Disease

Abstract

Ecthyma gangrenosum is a cutaneous lesion frequently associated with Pseudomonas aeruginosa bacteremia, although it may develop in the absence of bacteremia and may originate from other bacterial and fungal organisms. Ecthyma gangrenosum most often occurs in patients with neutropenia and other immunocompromised hosts. It typically occurs on the extremities and gluteal and perineal regions. We report a rare case of ecthyma gangrenosum presenting as an aggressive necrotic skin lesion on the nasal ala of a patient with myelofibrosis. Tissue and blood cultures were positive for P aeruginosa. This clinical entity should be considered when otolaryngologists are asked to evaluate necrotic cutaneous lesions of the head and neck.

Ecthyma Gangrenosum: A Rare Cutaneous Manifestation Caused byStenotrophomonas maltophiliain a Leukemic Patient

“…The bullae slough away, leaving ulcerated, necrotic centers with erythematous halos 3,13 . The maturation of the lesion is very rapid and often occurs in less than 24 hours as in our patient 11 . Fifty seven percent of skin lesions were located in the gluteal region, 30% on the extremities including the axillae, and 6% on the trunk.…”

“…The skin lesions of ecthyma gangrenosum are the manifes-tation of a necrotizing vasculitis 3 . The lesion characteristically begins as an erythematous nodule, macule, vesicle, or bullae and evolves into gangrenous ulcerations with black eschar and a surrounding rim of erythema 6,11,12 . The vesicles, initially filled with serous fluid, appear on the surface of the edematous skin, and then coalesce to form large bullae.…”

“…Early diagnosis and effective therapy are essential in the management of EG 6 . Treatment of EG involves the use of appropriate systemic antibiotics according to biopsy and blood culture results 11 . A combination of an aminoglycoside and an anti-pseudomonal β-lactam antibiotics is recommended for treatment of both bacteremic and nonbacteremic EG 6,11 .…”

“…Treatment of EG involves the use of appropriate systemic antibiotics according to biopsy and blood culture results 11 . A combination of an aminoglycoside and an anti-pseudomonal β-lactam antibiotics is recommended for treatment of both bacteremic and nonbacteremic EG 6,11 . Nonbacteremic patients with EG have relatively low mortality, ranging from 7% to 15% in a recent series, but the mortality rate in patients with bacteremia ranges from 38% to 96% 3 .…”

“…The physical finding of bullous cellulitis is associated with higher mortality, and the number of skin lesions is positively correlated with the severity of the disease 3 . Other prognostic factors include the time of onset of antibiotic therapy and the patient's response to therapy 11 .…”