Ecthyma Gangrenosum Mimicking Acute Invasive Fungal Sinusitis in an Immunocompromised Patient

Abstract

Ecthyma gangrenosum is a rare necrotizing cutaneous infection usuall y caused by Pseudomonas aeruginosa. We report a case of ecthyma gangrenosum presenting as a sinonasal eschar and mimicking acute invasivefungal sinusitis inan immunocompromised39-year-oldmanwith ahematologicmalignancy. To thebestofourknowledge, this represents thefirst case of ecthyma gangrenosum affecting the sinonasal mucosa to be repo rted in the literature.

Aggressive necrotizing pseudomonal sinonasal infections

“…Interestingly, 4 patients in this series presented with cranial nerve palsies (1 CN III, 2 CN II, and 3 CN V). This is different from the 1 previously reported case of sinonasal mucosal ecthyma gangrenosum, where the patient, though having severe sinonasal symptoms, did not actually have cranial nerve involvement . These cranial neuropathies, including 1 case of complete blindness and another case of relative afferent pupillary defect, initially led to a suspicion for malignancy or fungal infection before identifying the pseudomonal infection.…”

“…Though rare, such infections can manifest as isolated cutaneous and mucosal lesions in the form of ecthyma gangrenosum, especially in cases of pseudomonal sepsis and bacteremia. This condition, which accounts for only 1% to 6% of all pseudomonal infections, most commonly affects gluteal and perianal regions and the extremities; involvement of the head and neck, particularly the sinonasal tract, is exceedingly rare (<10%) . A unique characteristic of this infection is its propensity for vascular invasion leading to local tissue necrosis and, especially in immunosuppressed patients, it may mimic lesions seen in acute fulminant invasive fungal rhinosinusitis.…”

“…Kelley and Solowski et al . separately reported single cases of necrotizing pseudomonal infection of the nasal ala, whereas Hekiert et al . and Kleinberger et al .…”

Prevalence of skin infections, infestations, and papular urticaria among adolescents in secondary schools in Calabar, Nigeria

“…5 Adolescents who live in the tropics, particularly those in low income economies tend to present with a more varied range of dermatoses, and a higher prevalence of cutaneous infections than their contemporaries in other climes, even those in high income tropical regions. 3,[6][7][8] This study was conducted in Calabar, a city located in what is referred to as the South-South geopolitical zone of Nigeria. There are two distinct climatic seasons in Nigeria: the rainy season between March and October; and the dry season between November and February.…”

Facial gangrenous ecthyma: case report

“…It is associated with the presence of bacteremia due to PA, in immunocompromised patients. 1 It is characterized by producing ulcers surrounded by an erythematous halo, and as it progresses, a black eschar is also added. 2 A differential diagnosis should be made with acute invasive fungal rhinosinusitis, which also occurs in immunocompromised patients.…”