Ecthyma Gangrenosum of Scrotum in a Patient with Neutropenic Fever: A Case Report

Abstract

Patient: Male, 68Final Diagnosis: Echtyma gangrenosumSymptoms: Abdominal discomfort • fever • genital ulcerMedication: —Clinical Procedure: Antibiotic treatmentSpecialty: Infectious DiseasesObjective:Rare co-existance of disease or pathologyBackground:Ecthyma gangrenosum is an uncommon cutaneous infection commonly caused by Pseudomonas aeruginosa affecting typically immunocompromised patients. The presence of ecthyma gangrenosum can be associated with severe systemic infection often with a fatal prognosis. Most cases of ecthyma gangrenosum occur around the axilla, buttocks, and limbs; the scrotum is rarely affected.Case Report:A 68-year-old male with previously diagnosed acute myeloid leukemia, presented with left scrotal pain, fever, and rigors. Physical examination showed 2 ulcerating lesions with central black eschars surrounded by erythematous halos on the superior aspect of the left scrotum. Diagnosis of ecthyma gangrenosum was confirmed as both blood and lesion cultures showed growth of P. aeruginosa. After early empiric antibiotic treatment, the lesions significantly improved, and no sign of recurrence or new lesions was noticed.Conclusions:Ecthyma gangrenosum should be considered in the differential diagnosis of ulcerating lesions of the scrotum. An early diagnosis and aggressive antibiotic treatment are imperative for resolution of this infection.

Ecthyma gangrenosum: A view of blood on the skin

“…1 These lesions appear as painless erythematous papules, progressing to pustules/blisters; after exudation, they result in gangrenous ulcers with erythematous and hardened edges (Figure 2 ). 2 The patient evolved positively under targeted antibiotics (ceftazidime, 7 days), despite maintaining severe neutropenia. Later, she was diagnosed with aplastic anemia and allograft of hematopoietic cells was performed.…”

Multiple Necrotic Ulcers in a Patient with Felty Syndrome

“…Classically, EG is caused by Pseudomonas aeruginosa, an opportunistic agent and one of the leading causes of nosocomial infections, but other bacterial and fungal agents have also been described. 1,2 Cutaneous lesions commonly begin as a painless red macule that evolves to a papule, then to an haemorrhagic bullae that ruptures, forming a gray-black eschar with an erythematous halo. The most affected sites are axilla, extremities, gluteal and anogenital areas.…”

“…The face is rarely affected. 1,2 Two clinical forms are described: septic, with hematogenic spread from colonized gastrointestinal, genitourinary or respiratory tracts, and localized, that can result from direct inoculation of the skin or undetected low-grade transient bacteraemia. Multiple lesions suggest hematogenous dissemination, whereas solitary lesions usually result from direct skin inoculation.…”

An Eschar-like souvenir from a journey to Colombia: Ecthyma gangrenosum as a differential diagnosis of tropical diseases in immunocompromised patients – a case report

“…In the majority of the cases, EG develops in immunocompromised patients, such as patients with hematologic neoplasia, immunodeficiency syndromes, and patients receiving chemotherapy or immunosuppressive therapy [ 1 – 4 ]. Clinical manifestations of EG characteristically begin with erythematous skin lesions, which subsequently proceed to hemorrhagic bullae with necrotic areas or central black eschars, often surrounded by an erythematous halo [ 1 – 3 , 5 , 6 ]. Cultures of the skin lesions typically reveal P. aeruginosa, although co-detection of other bacteria or fungi is possible, and it is acknowledged that P. aeruginosa is not the only etiological agent of EG [ 1 , 7 ].…”

“…Ecthyma gangrenosum (EG) is a rare infectious disease of the skin mainly caused by Pseudomonas aeruginosa (P. aeruginosa) [1]. In the majority of the cases, EG develops in immunocompromised patients, such as patients with hematologic neoplasia, immunodeficiency syndromes, and patients receiving chemotherapy or immunosuppressive therapy [1][2][3][4]. Clinical manifestations of EG characteristically begin with erythematous skin lesions, which subsequently proceed to hemorrhagic bullae with necrotic areas or central black eschars, often surrounded by an erythematous halo [1-3, 5, 6].…”