Ecthyma gangrenosum without bacteremia in a 54‐year‐old woman with heart transplant

Hamed, Almutasem; Niehaus, Angela G.; Hughes, Olivia; Jakharia, Niyati

doi:10.1111/tid.13319

Cited by 6 publications

(6 citation statements)

References 15 publications

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“…This skin lesion without bacteremia has been described in heart, kidney, and bone marrow transplant recipients [8][9][10]. It has also been described in neutropenic patients [11].…”

Section: Discussionmentioning

confidence: 86%

A Challenging Cutaneous Lesion in a Patient With Chronic Idiopathic Neutropenia

Gkoufa¹,

Sklapani²,

Τράκας³

et al. 2022

Cureus

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Ecthyma gangrenosum (EG) is an uncommon necrotizing vasculitis that affects mainly immunocompromised and burn patients, and it is frequently associated with Pseudomonas aeruginosa bacteremia. However, cases of EG with other related pathogens and cases of EG affecting immunocompetent hosts have also been described in the literature. Besides, less common cases of EG without bacteremia have been reported. Herein, we describe a rare case of EG due to Pseudomonas aeruginosa without bacteremia in a patient with chronic idiopathic neutropenia (CIN). Considering the high mortality rate associated with EG, early diagnosis and appropriate effective treatment are crucial.

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“…This skin lesion without bacteremia has been described in heart, kidney, and bone marrow transplant recipients [8][9][10]. It has also been described in neutropenic patients [11].…”

Section: Discussionmentioning

confidence: 86%

A Challenging Cutaneous Lesion in a Patient With Chronic Idiopathic Neutropenia

Gkoufa¹,

Sklapani²,

Τράκας³

et al. 2022

Cureus

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“…This rare and fulminant infection associated with pseudomonal sepsis is characterized by round erythematous macules and patches that develop into central pustules with surrounding erythema, then haemorrhagic vesicles and eventually a gangrenous ulcer with a black eschar 9 . It is very rare in the DFI and usually occurs in the extremities of immune‐suppressed patients, 20 including in children 9 …”

Section: Discussionmentioning

confidence: 99%

“…We additionally believe that not all pathogens need specific antimicrobial coverage in DFIs. For instance, DFIs may resolve when patients are treated with antibiotics that do not cover selected bacteria (including Pseudomonas 20 and enterococci 25,26 ). Certainly, experts 5 acknowledge that every proven deep Pseudomonas infection of bone, and serious monomicrobial infections of the soft tissue, requires targeted antibiotic treatment, 23,27 whereas many chronic, ischaemic and polymicrobial soft‐tissue DFIs do not.…”

Section: Discussionmentioning

confidence: 99%

“…2 While many clinicians believe that the presence of a green colour or grape juice smell portends Pseudomonas, the only well-established clinical sign of P. aeruginosa infection is ecthyma gangrenosum. 20 This rare and fulminant infection associated with pseudomonal sepsis is characterized by round erythematous macules and patches that develop into central pustules with surrounding erythema, then haemorrhagic vesicles and eventually a gangrenous ulcer with a black eschar. 9 It is very rare in the DFI and usually occurs in the extremities of immune-suppressed patients, 20 including in children.…”

Section: Discussionmentioning

confidence: 99%

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How good are clinicians in predicting the presence ofPseudomonasspp. in diabetic foot infections? A prospective clinical evaluation

Uçkay

Holy

Schöni

et al. 2021

Endocrino Diabet & Metabol

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Introduction The most frequently prescribed empirical antibiotic agents for mild and moderate diabetic foot infections (DFIs) are amino‐penicillins and second‐generation cephalosporins that do not cover Pseudomonas spp. Many clinicians believe they can predict the involvement of Pseudomonas in a DFI by visual and/or olfactory clues, but no data support this assertion. Methods In this prospective observational study, we separately asked 13 experienced (median 11 years) healthcare workers whether they thought the Pseudomonas spp. would be implicated in the DFI. Their predictions were compared with the results of cultures of deep/intraoperative specimens and/or the clinical remission of DFI achieved with antibiotic agents that did not cover Pseudomonas. Results Among 221 DFI episodes in 88 individual patients, intraoperative tissue cultures grew Pseudomonas in 22 cases (10%, including six bone samples). The presence of Pseudomonas was correctly predicted with a sensitivity of 0.32, specificity of 0.84, positive predictive value of 0.18 and negative predictive value 0.92. Despite two feedbacks of the interim results and a 2‐year period, the clinicians' predictive performance did not improve. Conclusion The combined visual and olfactory performance of experienced clinicians in predicting the presence of Pseudomonas in a DFI was moderate, with better specificity than sensitivity, and did not improve over time. Further investigations are needed to determine whether clinicians should use a negative prediction of the presence of Pseudomonas in a DFI, especially in settings with a high prevalence of pseudomonal DFIs.

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“…Compared with immunocompetent individuals, SOT recipients have a higher risk for Gram negative bacteria, including multidrug resistant (MDR) pathogens [27–29]. A more severe variant, commonly regarded as a sign of underlying septicemia, is ecthyma gangrenosum, mainly caused by P. aeruginosa followed by E. coli [30].…”

Section: Bacteriamentioning

confidence: 99%

Skin and soft tissue infections in solid organ transplants

Peghin,

Graziano,

Grossi

2023

Current Opinion in Infectious Diseases

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Purpose of review Skin and soft tissue infections (SSTI) in solid organ transplant (SOT) recipients may be a great challenge for clinicians caring for SOT due to the involvement of both common and opportunistic pathogens associated with a blunted immune response. The purpose of this review is to outline current literature and describe open issues on the management of SSTI in this special population. Recent findings Clinical presentation in SOT recipients can manifest as isolated skin lesions after primary inoculation or be the sign of a disseminated infection. Tissue samples for microscopy and histopathology are crucial to making an accurate diagnosis given the nonspecific and heterogeneous appearance of skin lesions. Multidisciplinary teams are required for a comprehensive diagnosis and management. Summary SSTI are frequent contributors to morbidity and mortality in SOT. Specific research focused on the clinical presentation, risk factors and management in this special population is needed.

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Ecthyma gangrenosum without bacteremia in a 54‐year‐old woman with heart transplant

Cited by 6 publications

References 15 publications

A Challenging Cutaneous Lesion in a Patient With Chronic Idiopathic Neutropenia

A Challenging Cutaneous Lesion in a Patient With Chronic Idiopathic Neutropenia

How good are clinicians in predicting the presence ofPseudomonasspp. in diabetic foot infections? A prospective clinical evaluation

Skin and soft tissue infections in solid organ transplants

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