Ecthyma Gangrenosum in a Pediatric Patient and Review of the Literature

Ecthyma gangrenosum as a serious complication of Pseudomonas aeruginosa infection in departments of pediatric oncology

“…Ecthyma gangrenosum is an aggressive, infectious disease of the skin and mucous membranes, which in rare cases can take the form of vasculitis. Its development most often occurs as a result of direct infection of the skin of patients with chronic or immunodeficiency diseases and in patients with sepsis, most often with the aetiology of Pseudomonas aeruginosa (EG develops in up to 30% of people with bacteraemia [ 16 ]), however, there are cases of ecthyma gangrenosum in patients with a properly functioning immune system [ 18 – 20 ].…”

“…The lesions initially appear as red, painless macules, most often in the lumbar region, perineum and buttocks (57%), limbs (30%), face (6%), neck and torso (6%), which may be accompanied by non-specific symptoms, including abdominal pain, diarrhoea, fever and flu-like symptoms [ 4 , 6 , 9 , 18 , 24 ]. Ecthyma gangrenosum can present as single or multiple lesions [ 19 ].…”

“…The skin lesions then gradually increase and become papulae. The next stage is the stage of the hemorrhagic blister, which over time breaks and transforms into a black eschar surrounded by erythema – the transformation from a papula into an eschar takes 12 to 24 h. At the site of skin disruption, necrotic penetrating ulcers eventually appear [ 4 , 18 , 23 ].…”

“…Pathologically changed areas of the skin have a characteristic morphology, therefore they should be quickly diagnosed in order to avoid serious complications [ 18 ]. In most cases, ecthyma gangrenosum in the form of necrotic ulcers surrounded by erythema is a pathognomonic symptom of Pseudomonas aeruginosa sepsis, most of the time in patients with impaired immunity and neutropenia.…”

“…In the case of ecthyma gangrenosum caused by Pseudomonas aeruginosa in patients with immunodeficiency, it is particularly important to make a rapid diagnosis of the causative agent and implement appropriate targeted antibiotic therapy [ 10 , 21 ]. Neutropenia in children may result in the rapid progression of the disease, and thus lead to necrosis of new tissues [ 18 ].…”