Ecthyma gangrenosum in a neonate: not alwayspseudomonas

Abstract

SUMMARYEcthyma gangrenosum (EG) is a cutaneous manifestation of invasive infection usually caused by pseudomonas, but can be caused by many bacteria, fungal and viral infections. We present the first reported case of EG caused by invasive Escherichia coli in a neonate. A neonate presented with evidence of sepsis and a rapidly evolving 3×3.5 cm 2 well-circumscribed haemorrhagic and necrotic ulcer on the left groin. There was evidence of decreased perfusion of the lower limb owing to pressure effect of the ulcer. The child responded well to anticoagulation and antibiotic therapy. It is crucial to clinically suspect EG and promptly start empiric antibiotic therapy covering pseudomonas to decrease the morbidity and mortality. However, other viruses, fungus and bacteria including E coli should also be considered in the differential diagnosis of EG in a neonate. BACKGROUND

Ecthyma gangrenosum and ecthyma-like lesions: review article

“…EG caused by E. coli can occur following spontaneous bacterial peritonitis due to the same organism and Shiga toxinproducing E. coli can cooperate with P. aeruginosa sepsis in producing EG [65,66]. Such cases are usually associated with E. coli bacteremia [36,37,[65][66][67].…”

“…Of the 29 EG cases with various bacterial etiology, only two cases (6.9 % of bacterial etiology or 1.2 % of all cases) had positive blood cultures. Blood cultures were positive for Pseudomonas stutzeri [35] and Escherichia coli [36,37]. Fungal flora can also be cultured from the blood of patients with EG, as well as from the lesions.…”

Deficiency of Interleukin-1 Receptor-associated Kinase 4 Presenting as Fatal Pseudomonas aeruginosa Bacteremia in Two Siblings

“…This cutaneous lesion has been described as the initial manifestation of invasive infections in infants with PIDs or leukemia by Gram-negative bacteria (P. aeruginosa, Escherichia coli), Gram-positive bacteria (Staphylococcus aureus), viruses (Ηerpes simplex virus) and fungi (Mucorales and Aspergillus fumigatus). 8 Umbilical cord separation in our patient was observed between 21 and 28 days postpartum. This concurs with the definition that the upper limit of separation is more than 25 days.…”

Autoimmune Transient Neutropenia: A Case Report

“…It manifests through gangrenous ulcers with grayish-black eschars involved by an erythematous halo. The lesions usually appear in immunocompromised patients and are distributed especially in the perineal or gluteal region, extremities, trunk and face [9].…”