Reconstructive Procedure of Lower Lip Defect Due to Ecthyma Gangrenosum—A Rare Complication of Acute Lymphoblastic Leukemia

Abstract

Ecthyma gangrenosum is a rare invasive cutaneous infection mostly caused by Pseudomonas aeruginosa in immunosuppressed patients, especially during neutropenic states. Embolic lesions usually accompanying with septicemia of P. aeruginosa are typically painless, round, and centrally necrotic with a surrounding erythematous halo. Facial involvement occurred only in 6% of the patients, which may result to complicated defects for reconstruction. In this article, we aimed to present a case with relapse of acute lymphoblastic leukemia presented to our clinic with 50% defect of the lower lip due to ecthyma gangrenosum and its late-term reconstruction.

Eyelid and periorbital ecthyma gangrenosum due to Pseudomonas aeruginosa in an infant

“…These lesions most often occur in the gluteal and perineal regions (57%) or on the extremities (30%). Facial involvement is reported in about 6% of cases and can lead to skin defects that require reconstruction . Between 1974 and 2016, only two cases of facial EG in infancy were reported: one involved the eyelid and the other, the lips .…”

“…Facial involvement is reported in about 6% of cases and can lead to skin defects that require reconstruction. 3 Between 1974 and 2016, only two cases of facial EG in infancy were reported: one involved the eyelid and the other, the lips. 4,5 Several adult cases involving the eyelid and orbit have been reported in patients with leukemia or chemotherapy-related myelosuppression.…”

Pseudomonas aeruginosa ecthyma gangrenosum in a woman with recurrent Graves’ disease

“…The characteristic lesion begins as an erythematous nodule, vesicle, or bulla, and progresses rapidly to necrotic ulceration with a black eschar and erythematous rim. 1,2 Local infarction is due to arterial and venous thrombosis during bacterial multiplication. 1 Although P. aeruginosa is the most common pathogen causing EG, other bacteria (Staphylococcus aureus, Streptococcus, Aeromonas hydrophila, Serratia marcescens, Escherichia coli, Klebsiella, Neisseria meningitidis, Pseudomonas maltophilia, and Stenotrophomonas maltophilia) and some fungi (Aspergillus, Candida, Fusarium, and Rhizopus) can also cause EG-like lesions.…”

“…It is most commonly seen in immunocompromised subjects, but occasionally occurs in healthy people and in patients without bacteremia. 1,2 Although Graves' disease (GD) is a common organspecific autoimmune disease, 3 P. aeruginosa EG has been reported in only one GD patient with carbimazole-induced agranulocytosis. 4 We describe a woman with postoperative recurrent GD who suffered from P. aeruginosa EG and cellulitis.…”

Diagnosis and Management of Ecthyma Gangrenosum in Chronic Renal Failure Patient

“…As previously discussed, EG is frequently a progressive and possibly fatal disease with characteristic cutaneous manifestations and affected populations [1,2,3,4,5]. Despite having chronic renal failure on hemodialysis, the presented patient was not neutropenic and did not exhibit other manifestations of an immunocompromised state as associated with EG in previous reports [3,4,5]. Other potential etiologies include calciphylaxis, localized necrotic infection, given the surrounding excoriations, and superinfected pressure ulceration.…”