Ecthyma gangrenosum, a skin manifestation of Pseudomonas aeruginosa sepsis in a previously healthy child

Abstract

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.

Ecthyma gangrenosum in a 7‐year‐old girl: Is it a sign of acute lymphoblastic leukaemia?

“…2,3,5 Investigation of neutropaenia is a challenge as it may be a primitive condition predisposing to infection or be secondary to infection, as the pathogen may induce transitory neutropaenia through toxins capable of inhibiting granulocyte migration. 2,6 Neutropaenia, which is a common feature of immunocompromised patients and is rare in apparently healthy individuals, may show an underlying pathologic condition and F I G U R E 1 Ecthyma gangrenosum. Two lesions showing central necrosis surrounded by an erythematous halo on the abdomen demands further investigation to exclude possible causes.…”

“…In other cases, no predisposing condition was apparent. 6 Prognosis is variable depending on overall clinical conditions and extent of involvement, potentially becoming severe in case of bacteraemia. We witnessed a rapid clinical improvement following antibiotic therapy with piperacillintazobactam and amoxicillin-clavulanate.…”

“…Considering the development of different drug resistance mechanisms by this pathogen, 5 association of penicillin and beta lactamase inhibitor is the treatment of choice in PSAE infection. 5,6 Combination therapy is preferred to monotherapy because it carries increased efficacy and reduced risk of fatality. 2 In conclusion, EG is a rare cutaneous disorder because of PSAE infection that may be indicative of a septic state and, consequently, be potentially fatal.…”

“…Paediatric patients are often involved: EG has been described in immunocompromised subjects following heart transplant or suffering from ipogammaglobulinaemia or malignancies, such as in our case. In other cases, no predisposing condition was apparent . Prognosis is variable depending on overall clinical conditions and extent of involvement, potentially becoming severe in case of bacteraemia.…”

“…We witnessed a rapid clinical improvement following antibiotic therapy with piperacillin‐tazobactam and amoxicillin‐clavulanate. Considering the development of different drug resistance mechanisms by this pathogen, association of penicillin and beta lactamase inhibitor is the treatment of choice in PSAE infection . Combination therapy is preferred to monotherapy because it carries increased efficacy and reduced risk of fatality…”