1
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Klein PA, Wagner GA, Barr RJ, Klein JA, Rogers RS. Empiric intralesional tumescent drug delivery of antimicrobials effectively treated a painful necrotizing skin infection. JAAD Case Rep 2024; 50:40-43. [PMID: 39036615 PMCID: PMC11259981 DOI: 10.1016/j.jdcr.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Affiliation(s)
| | - Gerald A. Wagner
- Department of Pediatrics, University of California Irvine, Irvine, California
| | - Ronald J. Barr
- Department of Dermatology, University of California Irvine, Irvine, California
| | - Jeffrey A. Klein
- Department of Dermatology, University of California Irvine, Irvine, California
| | - Roy S. Rogers
- Department of Dermatology, Mayo Clinic Arizona, Phoenix, Arizona
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2
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Becker SL, Kody S, Fett NM, Hines A, Alavi A, Ortega-Loayza AG. Approach to the Atypical Wound. Am J Clin Dermatol 2024; 25:559-584. [PMID: 38744780 DOI: 10.1007/s40257-024-00865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
The heterogeneity of atypical wounds can present diagnostic and therapeutic challenges; however, as the prevalence of atypical wounds grows worldwide, prompt and accurate management is increasingly an essential skill for dermatologists. Addressing the underlying cause of an atypical wound is critical for successful outcomes. An integrated approach with a focus on pain management and patient engagement is recommended to facilitate enduring wound closure. Advances in treatment, in addition to further research and clinical training, are necessary to address the expanding burden of atypical wounds.
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Affiliation(s)
- Sarah L Becker
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | - Shannon Kody
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | - Nicole M Fett
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | | | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA.
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3
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Lama IY, Cheung LK, James A, Saghir M, Herd F, Greenhowe J. Ecthyma gangrenosum: A case report in a child with acute lymphoblastic leukaemia. JPRAS Open 2024; 40:215-221. [PMID: 38681531 PMCID: PMC11047190 DOI: 10.1016/j.jpra.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/18/2024] [Indexed: 05/01/2024] Open
Abstract
Aim We present a case of Ecthyma gangrenosum (EG) affecting left thigh in a child with acute lymphoblastic leukaemia (ALL) with an aim to raise awareness about this condition. Case presentation A 7-year-old female child who presented with lethargy, pallor and lumps to inner lip was diagnosed with B-cell precursor ALL. She was started on treatment as per UKALL 2011 guidelines Regime B. On day 28, she developed neutropenic sepsis along with a new lesion in her left thigh. She was started on intravenous Meropenum, Gentamicin and Caspofungin. The clinical diagnosis of EG was made based on lesion progression, positive blood and wound swab & tissue cultures for Pseudomonas aeruginosa and patient's immunocompromised status. The wound healed with secondary intention following debridement. We present a series of photographs to demonstrate her remarkable improvement. Discussion EG occurs in 1-30% of cases of Pseudomonas sepsis; other bacteria and fungi can be associated with this condition. It is identified more in oncology patients as seen in our patient. A multidisciplinary team approach should be provided in 3 stages with empirical antibiotics, followed by targeted antibiotics or antifungals & surgical debridement. Our patient was treated in similar fashion and made a good recovery. Conclusion It is a rare skin condition associated with a high mortality. We suggest all clinicians to be vigilant about this condition to be able to provide accurate diagnosis and prompt treatment to improve the overall prognosis.
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Affiliation(s)
- I Yonjan Lama
- Royal Aberdeen Children's Hospital, Department of Plastic Surgery, Aberdeen, Scotland, UK
| | - LK Cheung
- Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - A James
- Aberdeen Royal Infirmary, Department of Plastic surgery, Aberdeen, Scotland, UK
| | - M Saghir
- Aberdeen Royal Infirmary, Department of Plastic surgery, Aberdeen, Scotland, UK
| | - F Herd
- Royal Aberdeen Children's Hospital, Department of Oncology, Aberdeen, Scotland, UK
| | - J Greenhowe
- Royal Aberdeen Children's Hospital, Department of Plastic Surgery, Aberdeen, Scotland, UK
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4
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Zoric A, Bagheri M, von Kohout M, Fardoust T, Fuchs PC, Schiefer JL, Opländer C. High-Intensity Blue Light (450-460 nm) Phototherapy for Pseudomonas aeruginosa-Infected Wounds. Photobiomodul Photomed Laser Surg 2024; 42:356-365. [PMID: 38776546 DOI: 10.1089/photob.2023.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Background: Nosocomial wound infection with Pseudomonas aeruginosa (PA) is a serious complication often responsible for the septic mortality of burn patients. Objective: High-intensity antimicrobial blue light (aBL) treatment may represent an alternative therapy for PA infections and will be investigated in this study. Methods: Antibacterial effects of a light-emitting diode array (450-460 nm; 300 mW/cm2; 15/30 min; 270/540 J/cm2) against PA were determined by suspension assay, biofilm assay, and a human skin wound model and compared with 15-min topically applied 3% citric acid (CA) and wound irrigation solution (Prontosan®; PRT). Results: aBL reduced the bacterial number [2.51-3.56 log10 colony-forming unit (CFU)/mL], whereas PRT or CA treatment achieved a 4.64 or 6.60 log10 CFU/mL reduction in suspension assays. aBL reduced biofilm formation by 60-66%. PRT or CA treatment showed reductions by 25% or 13%. Here, aBL reduced bacterial number in biofilms (1.30-1.64 log10 CFU), but to a lower extend than PRT (2.41 log10 CFU) or CA (2.48 log10 CFU). In the wound skin model, aBL (2.21-2.33 log10 CFU) showed a bacterial reduction of the same magnitude as PRT (2.26 log10 CFU) and CA (2.30 log10 CFU). Conclusions: aBL showed a significant antibacterial efficacy against PA and biofilm formation in a short time. However, a clinical application of aBL in wound therapy requires effective active skin cooling and eye protection, which in turn may limit clinical implementation.
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Affiliation(s)
- Andreas Zoric
- Department of Plastic, Reconstructive and Aesthetic Surgery, RKH Hospital Bietigheim-Vaihingen, Bietigheim-Bissingen, Germany
| | - Mahsa Bagheri
- Department of Plastic and Aesthetic Surgery, Hand Surgery, HELIOS Hospital Emil von Behring, Berlin, Berlin, Germany
| | - Maria von Kohout
- Department of Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Cologne, Germany
| | - Tara Fardoust
- Institute for Research in Operative Medicine (IFOM), Cologne-Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Paul C Fuchs
- Department of Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Cologne, Germany
| | - Jennifer L Schiefer
- Department of Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Cologne, Germany
| | - Christian Opländer
- Institute for Research in Operative Medicine (IFOM), Cologne-Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
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5
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Kalyanaprabhakaran B, Kumar VR, Ramamoorthy JG, Karunakar P, Gunasekaran D, Jindal B. Extensive perineal ecthyma gangrenosum in leukocyte adhesion deficiency type 1 associated with Staphylococcus hominis bacteremia. Pediatr Dermatol 2024; 41:501-503. [PMID: 38151231 DOI: 10.1111/pde.15492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023]
Abstract
Leukocyte adhesion deficiency (LAD), a disorder of neutrophil function, is characterized by a defect in leukocyte adhesion to the endothelium. Recurrent infections in the skin, soft tissue, gingiva, and lungs due to Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella sp. are common in these patients. Ecthyma gangrenosum (EG) is an ulcer of skin and subcutaneous tissue with a black eschar and surrounding erythematous halo secondary to a bacterial infection. Here, we report an unusual presentation of LAD type-1 with extensive EG of perineum secondary to Staphylococcus hominis bacteremia treated successfully with combination of granulocyte transfusion and diversion colostomy.
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Affiliation(s)
- Balamurugan Kalyanaprabhakaran
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Venkataraman Ranjith Kumar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | | | - Pediredla Karunakar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Dhandapany Gunasekaran
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Bibekanand Jindal
- Department of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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6
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Saito U, Minamikawa S, Otake S, Ishida Y, Mizuta M, Ishida T, Karakawa S, Kasai M, Nakagishi Y. A PEDIATRIC CASE OF PANNICULITIS INDUCED BY Pseudomonas aeruginosa WITH CLINICAL FEATURES SIMILAR TO ECTHYMA GANGRENOSUM. Pediatr Infect Dis J 2024:00006454-990000000-00832. [PMID: 38621161 DOI: 10.1097/inf.0000000000004363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
The clinical features of panniculitis caused by Pseudomonas aeruginosa, in contrast to those caused by ecthyma gangrenosum, remain unknown. Here, we report a pediatric case of P. aeruginosa panniculitis. The patient had systemic involvement without bacteremia and also had a background of autoimmune neutropenia. These features are common in ecthyma gangrenosum but have not been reported in P. aeruginosa-induced panniculitis.
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Affiliation(s)
- Urara Saito
- From the Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital
| | - Shogo Minamikawa
- From the Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe
| | - Shogo Otake
- Division of Infectious Diseases, Department of Pediatrics
| | - Yusuke Ishida
- From the Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital
| | - Mao Mizuta
- From the Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital
| | - Toshiaki Ishida
- Department of Hematology and Oncology, Kobe Children's Hospital, Hyogo
| | - Shuhei Karakawa
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Masashi Kasai
- Division of Infectious Diseases, Department of Pediatrics
| | - Yasuo Nakagishi
- From the Department of General Pediatrics, Hyogo Prefectural Kobe Children's Hospital
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7
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Mansilla-Polo M, Martín-Torregrosa D, Becerril-Andrés S, Botella-Estrada R. 'Lesion on the back of the hand in a hematopoietic stem cell transplant recipient'. Infection 2024:10.1007/s15010-024-02214-z. [PMID: 38485890 DOI: 10.1007/s15010-024-02214-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/10/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Miguel Mansilla-Polo
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
- Health Research Institute (IIS) La Fe, Valencia, Spain.
- Faculty of Medicine, University of Valencia, Valencia, Spain.
| | - Daniel Martín-Torregrosa
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Health Research Institute (IIS) La Fe, Valencia, Spain
| | - Sara Becerril-Andrés
- Department of Dermatology, University Clinical Hospital of Salamanca, Salamanca, Spain
| | - Rafael Botella-Estrada
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Health Research Institute (IIS) La Fe, Valencia, Spain
- Faculty of Medicine, University of Valencia, Valencia, Spain
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8
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McHugh JW, Lehman JS, Shah A. Pseudomonas aeruginosa-Associated Ecthyma Gangrenosum: A Classic Presentation. Mayo Clin Proc 2024; 99:336-337. [PMID: 38309940 DOI: 10.1016/j.mayocp.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/05/2023] [Indexed: 02/05/2024]
Affiliation(s)
- Jack W McHugh
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN.
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Aditya Shah
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN
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9
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Bagheri M, Zoric A, von Kohout M, Fuchs PC, Schiefer JL, Opländer C. The Antimicrobial Efficacy of Topically Applied Mafenide Acetate, Citric Acid and Wound Irrigation Solutions Lavanox and Prontosan against Pseudomonas aeruginosa. Antibiotics (Basel) 2024; 13:42. [PMID: 38247601 PMCID: PMC10812663 DOI: 10.3390/antibiotics13010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Since burn wound infections caused by Pseudomonas aeruginosa (PA) lead to major complications and sepsis, this study evaluates the antimicrobial efficacy of the wound irrigation solutions Prontosan (PRT), Lavanox (LAV), citric acid (CA) and mafenide acetate (MA) using microbiology assays and an ex vivo skin wound model. In suspension assays, all the solutions showed significant reductions in bacterial number (log10 reduction: CA 5.77; LAV 4.91; PRT 4.74; MA 1.23). The biofilm assay revealed that PRT and LAV reduced biofilm formation by ~25% after a 15 min treatment, while PRT was most effective after a 24 h treatment (~68%). The number of PA in biofilms measured directly after a 15 min treatment was reduced most effectively with CA and LAV (log10 reductions ~2.5), whereas after a 24 h treatment, all solutions achieved only 1.36-1.65 log10 reductions. In the skin wound model, PRT and LAV provided the highest bacterial reduction after a 15 min treatment (log10 reduction 1.8-1.9), while MA was more effective after a 22 h treatment (log10 reduction 3.6). The results demonstrated the antimicrobial efficacy of all solutions against PA. Further investigation is needed to explore the potential clinical applications of a combination or alternating use of these solutions for infection prophylaxis and treatment of wound infections caused by PA.
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Affiliation(s)
- Mahsa Bagheri
- Department of Plastic and Aesthetic Surgery, Hand Surgery, HELIOS Hospital Emil von Behring, Walterhoeferstr. 11, 14165 Berlin, Germany
| | - Andreas Zoric
- Plastic, Reconstructive and Aesthetic Surgery, RKH Hospital Bietigheim-Vaihingen, Riedstr. 12, 74321 Bietigheim-Bissingen, Germany
| | - Maria von Kohout
- Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Paul C. Fuchs
- Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Jennifer Lynn. Schiefer
- Plastic Surgery, Hand Surgery, Burn Center, Cologne-Merheim Hospital, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Christian Opländer
- Institute for Research in Operative Medicine (IFOM), Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str. 200, 51109 Cologne, Germany
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10
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Castater C, Bishop E, Santos A, Freedberg M, Kim P, Sciarretta C. Diabetic Soft Tissue Infections. Surg Clin North Am 2023; 103:1191-1216. [PMID: 37838463 DOI: 10.1016/j.suc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Diabetes is a systemic illness that can cause a broad range of physiologic effects. Infection rates and wound healing are both affected through multiple mechanisms. Other physiologic changes increase risk for wounds as well as complex soft tissue infections ranging from simple cellulitis to necrotizing soft tissue infections. Clinicians and surgeons need to have a low index of suspicion for severe infection in a patient presenting with diabetes, and even more so in patients with uncontrolled diabetes.
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Affiliation(s)
- Christine Castater
- Morehouse School of Medicine, Grady Memorial Hospital 1C-144, 80 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA.
| | - Elliot Bishop
- Emory University, Grady Memorial Hospital Glenn Building 69 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA
| | - Adora Santos
- Emory University, Grady Memorial Hospital Glenn Building 69 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA
| | - Mari Freedberg
- Emory University, Grady Memorial Hospital Glenn Building 69 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA
| | - Phillip Kim
- Emory University, Grady Memorial Hospital Glenn Building 69 Jesse Hill Jr Drive Southeast, Atlanta, GA 30303, USA
| | - Christopher Sciarretta
- University of Tennessee, University of Tennessee College of Medicine, 975 3rd Avenue, Chattanooga, TN 37403, USA
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11
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Filali I, Azitoune S, El Moussaoui S, Kriouile Y. Ecthyma gangrenosum as the first presentation of acute lymphocytic leukaemia in an infant. BMJ Case Rep 2023; 16:e256683. [PMID: 38000809 PMCID: PMC10679998 DOI: 10.1136/bcr-2023-256683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023] Open
Affiliation(s)
- Imane Filali
- Pediatric, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Sanae Azitoune
- Neuropediatric unit, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Sanae El Moussaoui
- Neuropediatric unit, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Yamna Kriouile
- Neuropediatric unit, Ibn Sina University Hospital Center, Rabat, Morocco
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12
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Galassi FM, Giacomini F, Varotto E. Palaeodermatological aspects of Duke Federico da Montefeltro's case: A multidisciplinary assessment. J Eur Acad Dermatol Venereol 2023; 37:2168-2170. [PMID: 37382055 DOI: 10.1111/jdv.19250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Francesco M Galassi
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | | | - Elena Varotto
- FAPAB Research Center, Avola (SR), Sicily, Italy
- Archaeology, College of Humanities, Arts and Social Sciences, Flinders University, Adelaide, South Australia, Australia
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13
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Lau WC, Yang K, Lau CB, Pan CX, Kassamali B, Nambudiri VE. Clinicopathologic features of ecthyma gangrenosum: a single integrated health system cohort. Arch Dermatol Res 2023; 315:2717-2719. [PMID: 37432465 DOI: 10.1007/s00403-023-02655-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/19/2023] [Accepted: 06/18/2023] [Indexed: 07/12/2023]
Abstract
Ecthyma gangrenosum is an uncommon cutaneous eruption that can initially present with painless macules, which rapidly evolve into necrotic ulcers. This study sought to characterize clinicopathologic features of ecthyma gangrenosum from a single integrated health system. Our cohort consisted of 82 individuals diagnosed with ecthyma gangrenosum. Lesions were most commonly found in the lower extremities (55%) and the truncal region (20%). A wide variety of fungal and bacterial etiologies were found among our cohort. The majority of patients with EG were immunocompromised (79%) and 38% of patients also experienced sepsis. The mortality rate seen in our cohort was approximately 34%. No statistical differences in mortality outcome due to EG related complications were seen between pathogen etiology, and distribution or location of lesions. Patients who were septic or immunocompromised died more frequently than non-septic or immunocompetent patients, suggesting poorer prognosis.
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Affiliation(s)
- William C Lau
- Boston University School of Medicine, Boston, MA, USA
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Kevin Yang
- Tufts University School of Medicine, Boston, MA, USA
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Charles B Lau
- Boston University, Boston, MA, USA
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Catherina X Pan
- Harvard Medical School, Boston, MA, USA
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Bina Kassamali
- Harvard Medical School, Boston, MA, USA
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Vinod E Nambudiri
- Harvard Medical School, Boston, MA, USA.
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA.
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14
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Kim-Lim P, Thomas C. Scattered Painful Papulonodules in an Older Woman. JAMA Oncol 2023; 9:1291-1292. [PMID: 37471070 DOI: 10.1001/jamaoncol.2023.2170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
A 56-year-old woman was admitted for myeloablative conditioning in preparation for allogeneic hematopoietic cell transplant. Her course was complicated by severe mucositis, acute kidney injury, and neutropenic fever. During her admission, she also developed painful necrotic skin lesions, a nonproductive cough, and altered mental status. What is your diagnosis?
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Affiliation(s)
| | - Cristina Thomas
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas
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15
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Cortese A, Manara S, Pancetti S, Toso F, Fiorillo G, Costanzo A, Borroni RG. Bullous ecthyma gangrenosum of the scalp during Pseudomonas aeruginosa sepsis. Ital J Dermatol Venerol 2023; 158:74-75. [PMID: 36939512 DOI: 10.23736/s2784-8671.22.07414-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Affiliation(s)
- Andrea Cortese
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy -
- Unit of Dermatology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy -
| | - Sofia Manara
- Unit of Pathology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Saverio Pancetti
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy
- Unit of Pathology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Francesco Toso
- Unit of Dermatology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Giovanni Fiorillo
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy
- Unit of Dermatology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Antonio Costanzo
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy
- Unit of Dermatology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Riccardo G Borroni
- Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy
- Unit of Dermatology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
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16
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Nakatani R, Ashiarai M, Yoshihara H, Yada K, Nozaki T, Ushigusa T, Mori N, Hasegawa D. Multidisciplinary management of disseminated Exophiala dermatitidis mycosis in an infant with mixed phenotype acute leukemia: a case report. BMC Infect Dis 2022; 22:797. [PMID: 36274136 PMCID: PMC9590134 DOI: 10.1186/s12879-022-07773-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Exophiala dermatitidis is a dematiaceous fungus isolated from various environmental sources. Systemic E. dermatitidis infections can lead to fatal outcomes, and treatment has not yet been standardized. Although E. dermatitidis is also known to cause cutaneous infection, it has not been previously reported to appear as ecthyma gangrenosum (EG), an uncommon cutaneous lesion in neutropenic patients that is mainly caused by Pseudomonas aeruginosa. Case presentation A 2-month-old male infant with mixed-phenotype acute leukemia presented with prolonged fever unresponsive to antibacterial and antifungal agents during myelosuppression due to remission induction therapy. He also presented with skin lesions on the left wrist and left lower quadrant of the abdomen. The abdominal lesion gradually turned black and necrotic, which was consistent with the findings of the EG. E. dermatitidis was isolated from the blood, stool, wrist skin, and endotracheal aspirate. During hematopoietic recovery, consolidation in both lungs was evident. Multiagent antifungal treatment failed to eliminate E. dermatitidis from blood. In order to salvage the central venous catheter, ethanol lock therapy (ELT) was adopted, following which the blood culture became negative. The abdominal lesion that evolved as a necrotic mass connecting the small intestine and subcutaneous tissue adjacent to the skin was surgically resected. After these interventions, the general condition improved. Conclusion Disseminated E. dermatitidis mycosis in the neutropenic infant was successfully managed with a multidisciplinary treatment consisting of multiagent antifungal treatment, ELT, and surgery.
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Wan Ahmad Kammal WSL, Mohamad Fazial NS, Jamil A. Necrotic ulcers in an immunocompromised patient. Eur J Intern Med 2022; 103:102-103. [PMID: 35597735 DOI: 10.1016/j.ejim.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/09/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Wan Syazween Lyana Wan Ahmad Kammal
- Dermatology Unit, Internal Medicine Department, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang, Malaysia.
| | - Nur Shairah Mohamad Fazial
- Dermatology Unit, Department of Medicine, Universiti Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
| | - Adawiyah Jamil
- Dermatology Unit, Department of Medicine, Universiti Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
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18
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Engelhardt S, Dislich B, Zubler C, Maragkou T, Wartenberg M, Tzankov A. Myositis als postakute Folge einer COVID-19-Erkrankung? DIE PATHOLOGIE 2022; 43:377-380. [PMID: 35376988 PMCID: PMC8978168 DOI: 10.1007/s00292-022-01063-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/30/2022]
Abstract
Es wird über eine an COVID-19 erkrankte Patientin mit Verdacht auf eine Myositis als Folge einer SARS-CoV-2-Infektion berichtet. Initial führte wenig Information über die Krankengeschichte zur erschwerten histopathologischen Interpretation. Im Verlauf konnten weitere Details eruiert und die Diagnose einer infektassoziierten thrombotischen Mikroangiopathie im Rahmen einer Morganella-morganii-Myositis gestellt werden. Der Fall zeigt, dass auch in Zeiten der allgegenwärtigen Pandemie und selbst bei positivem COVID-19-Test Differentialdiagnosen sowie der integrative klinisch-pathologische Ansatz bei der Befundung von Muskelbiopsien nicht außer Acht gelassen werden sollten.
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Affiliation(s)
- S Engelhardt
- Institut für Medizinische Genetik und Pathologie, Universitätsspital Basel, Schönbeinstrasse 40, 4031, Basel, Schweiz.
| | - B Dislich
- Institut für Pathologie, Universität Bern, Bern, Schweiz
| | - C Zubler
- Departement für Plastische- und Handchirurgie, Inselspital Universitätsspital Bern, Bern, Schweiz
| | - T Maragkou
- Institut für Pathologie, Universität Bern, Bern, Schweiz
| | - M Wartenberg
- Institut für Pathologie, Universität Bern, Bern, Schweiz
| | - A Tzankov
- Institut für Medizinische Genetik und Pathologie, Universitätsspital Basel, Schönbeinstrasse 40, 4031, Basel, Schweiz
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19
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Ismail IH, Adam J. Ecthyma gangrenosum as a presenting feature of X-linked agammaglobulinemia: A case study. Pediatr Neonatol 2022; 63:549-550. [PMID: 35431148 DOI: 10.1016/j.pedneo.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/06/2022] [Accepted: 02/14/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Intan Hakimah Ismail
- Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
| | - Julia Adam
- Department of Paediatrics, Women and Children Hospital Kuala Lumpur, 50586 Jalan Pahang, Kuala Lumpur, Malaysia
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20
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(Kudo) Nagata Y, Sekiya N, Fukushima K, Horiuchi M, Doki N. Ecthyma gangrenosum caused by Staphylococcus aureus in hematological malignancies: Case reports and literature review. Medicine (Baltimore) 2022; 101:e30070. [PMID: 35984202 PMCID: PMC9388014 DOI: 10.1097/md.0000000000030070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Ecthyma gangrenosum (EG) is a potentially life-threatening, systemic infection generally caused by Pseudomonas aeruginosa. Data on EG caused by Staphylococcus aureus in patients with hematological malignancies are scarce. The present case report aimed to describe the clinical features of EG caused by S. aureus in patients with hematological malignancies and to provide a comprehensive review of previous studies on the topic. PATIENT CONCERNS The first patient was a 61-year-old man with acute myeloid leukemia who presented fever and multiple lesions during chemotherapy. The second patient was a 47-year-old man with myelodysplastic syndrome who developed progressive erythematous necrotic plaques on his extremities and face. DIAGNOSIS Both cases were diagnosed as EG caused by S. aureus. While the first patient had concurrent methicillin-resistant S. aureus (MRSA) bacteremia, the second patient had positive results only for tissue culture of the skin lesion isolated methicillin-sensitive S. aureus. INTERVENTIONS Vancomycin was initiated with critical care to the first patient. Cefazolin was administered to the second patient for 3 weeks, followed by cephalexin for 1 week. OUTCOMES The first patient died of a brain hemorrhage and multiple organ failure. The second patient was cured without relapse. LESSONS Of 18 patients in the previous and current studies with EG caused by S. aureus, 6 (33%) had an underlying hematological malignancy, and 10 (56%) had EG caused by MRSA. While 28% of the patients had positive blood cultures, all tissue cultures were positive. All 3 fatalities had concurrent bacteremia (MRSA caused two). EG caused by MRSA with concurrent bacteremia can be fatal, especially in patients with hematological malignancies. Although S. aureus-associated EG in patients with hematological malignancies is relatively uncommon, tissue cultures with an initial gram stain smear are essential for selecting appropriate empirical antimicrobials, including the coverage of S. aureus.
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Affiliation(s)
- Yuka (Kudo) Nagata
- Department of Infection Prevention and Control, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Noritaka Sekiya
- Department of Infection Prevention and Control, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
- Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
- *Correspondence: Noritaka Sekiya, Department of Infection Prevention and Control, Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Hon-Komagome, Bunkyo-ku, Tokyo 113-8677, Japan (e-mail: )
| | - Kazuaki Fukushima
- Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Masao Horiuchi
- Department of Infection Prevention and Control, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Noriko Doki
- Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
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21
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Seabra Rato M, Bernardo A, Oliveira Pinheiro F, Guimarães da Fonseca D, Costa L. The skin as the first sign of a rare complication of rheumatoid arthritis. Clin Rheumatol 2022; 41:3583-3584. [DOI: 10.1007/s10067-022-06303-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/26/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022]
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22
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Dilly B, Grémain V, Masmoudi W, Noël D. A cheek lesion. Rev Med Interne 2022; 43:570-571. [PMID: 35623926 DOI: 10.1016/j.revmed.2022.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Affiliation(s)
- B Dilly
- Service de médecine interne, Centre Hospitalier Intercommunal Elbeuf Louviers Val de Reuil, Saint Aubin Lès Elbeuf, France.
| | - V Grémain
- Service de médecine interne-rhumatologie, Groupe Hospitalier du Havre, Montivilliers, France
| | - W Masmoudi
- Service de médecine interne, Centre Hospitalier Intercommunal Elbeuf Louviers Val de Reuil, Saint Aubin Lès Elbeuf, France
| | - D Noël
- Service de médecine interne, Centre Hospitalier Intercommunal Elbeuf Louviers Val de Reuil, Saint Aubin Lès Elbeuf, France
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23
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Prevalence and clinical features of secondary skin lesions in septic patients with bloodstream infections. Eur J Clin Microbiol Infect Dis 2022; 41:779-786. [PMID: 35320429 DOI: 10.1007/s10096-022-04431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/14/2022] [Indexed: 11/03/2022]
Abstract
Cutaneous manifestations developed in the course of sepsis are poorly documented in the medical literature beyond those related to specific pathogens or classical clinical pictures such as purpura fulminans or ecthyma gangrenosum. The objective of this study was to determine the overall prevalence of sepsis-related skin findings and evaluate their possible impact on the prognosis of septic patients. Single-centre, retrospective study of septic patients with documented bloodstream infections admitted in a tertiary hospital during 2019. Primary skin and soft tissue infections, and non-sepsis-related skin conditions diagnosed during hospital admission were excluded. Unselected sample of 320 episodes of sepsis in 265 patients. Secondary skin lesions were documented in 57 sepsis episodes (17.8%) in 47 patients. Purpura (petechiae/ecchymosis) was the most frequent cutaneous finding in septic patients (35.5%), with non-acral involvement in more than one-third of the episodes (38.5%), followed by skin and soft tissue erythema/oedema (25.8%) and maculopapular rashes (11.3%). Secondary skin lesions occurred more frequently in sepsis of respiratory (p = 0.027) and skin and soft tissue (p = 0.018) origin, as well as in sepsis caused by Pseudomonas aeruginosa and Stenotrophomonas maltophilia (p = 0.001). Mean hospital stay was 38.58 days and sepsis-related mortality 21.1%. Our results suggest that cutaneous involvement in the course of sepsis is frequent, with purpura being the main clinical sign. The semiology described in this study, easily identifiable by non-dermatologists, should alert clinicians to the potential unfavourable course of these patients.
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24
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Gonzaga Y, Jeunon T, Machado J, Nucci M. Ecthyma gangrenosum in neutropenic patients and the importance of an early skin scraping for direct examination. An Bras Dermatol 2022; 97:534-536. [PMID: 35654651 PMCID: PMC9263667 DOI: 10.1016/j.abd.2020.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yung Gonzaga
- Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil.
| | | | - Jorge Machado
- Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil
| | - Marcio Nucci
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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25
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Tanaka A, Yanagi T, Seo T, Mai S, Miyazawa H, Ujiie H. Ecthyma gangrenosum caused by Streptococcus pyogenes: Report of a case and review of the literature. J Dermatol 2022; 49:e266-e267. [PMID: 35438202 DOI: 10.1111/1346-8138.16396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/28/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Arisa Tanaka
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Teruki Yanagi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashi Seo
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shoko Mai
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hajime Miyazawa
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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26
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Tvedten E, Marion T, Motaparthi K. Necrotic Plaques on the Ears of a Patient With COVID-19. JAMA Dermatol 2022; 158:579-580. [PMID: 35416915 DOI: 10.1001/jamadermatol.2022.0745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Erika Tvedten
- Michigan State University College of Osteopathic Medicine, East Lansing
| | - Tyler Marion
- Department of Dermatology, University of Florida College of Medicine, Gainesville
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville
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27
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Ribeiro M, Marinho P, Camilo C, Pinto S. Ecthyma gangrenosum as a clue to pseudomonas septicaemia. BMJ Case Rep 2022; 15:e249114. [PMID: 35318208 PMCID: PMC8943720 DOI: 10.1136/bcr-2022-249114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Marta Ribeiro
- Paediatrics, Hospital de Santa Maria, Lisboa, Portugal
| | - Pedro Marinho
- Infectious Diseases and Immunodeficiency Unit, Pediatrics Department, Hospital de Santa Maria, Lisboa, Portugal
- Paediatrics Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Cristina Camilo
- Pediatria-Unidade de Cuidados Intensivos Pediátricos, Hospital Santa Maria-Departamento da Criança e da Família-CHLN, Lisbon, Portugal
| | - Sara Pinto
- Infectious Diseases and Immunodeficiency Unit, Pediatrics Department, Hospital de Santa Maria, Lisboa, Portugal
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28
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Muggeo P, Zama D, Decembrino N, Onofrillo D, Frenos S, Colombini A, Perruccio K, Calore E, Giurici N, Ficara M, La Spina M, Mura R, De Santis R, Santoro N, Cesaro S. Ecthyma Gangrenosum in Children With Cancer: Diagnosis at a Glance: A Retrospective Study From the Infection Working Group of Italian Pediatric Hematology Oncology Association. Pediatr Infect Dis J 2022; 41:238-242. [PMID: 34694251 DOI: 10.1097/inf.0000000000003377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To depict ecthyma gangrenosum (EG) clinical presentation and evolution in a large multicenter pediatric retrospective collection of children with malignancies or bone marrow failure syndromes, to facilitate early diagnosis. METHODS EG episodes diagnosed in the period 2009-2019 were identified by a retrospective review of clinical charts at centers belonging to the Italian Pediatric Hematology Oncology Association. RESULTS Thirty-eight cases of EG occurring in children (male/female 16/22; median age 5.2 years) with hematologic malignancy (29), allogeneic stem cell transplantation (2) or relapsed/refractory solid tumor (3) were collected. The involved sites were: perineal region (19), limbs (10), trunk (6), head and the iliac crest (3). Bacteremia was present in 22 patients. Overall, the germs isolated were Pseudomonas aeruginosa (30), Stenotrophomonas maltophilia (3) and Escherichia coli (1); 31% of them were multidrug-resistant. All patients received antibacterial treatment, while surgery was performed in 24 patients (63.1%). Predisposing underlying conditions for EG were severe neutropenia (97.3%), corticosteroid treatment (71%) and iatrogenic diabetes (23.7%). All patients recovered, but EG recurred in 5 patients. Nine patients (24%) showed sequelae (deep scars, with muscle atrophy in 2). Four patients (10.5%) died, 1 due to relapse of EG with Carbapenem-resistant Enterobacteriaceae co-infection and 3 due to the progression of the underlying disease. CONCLUSIONS EG requires early recognition and a proper and timely treatment to obtain the recovery and to avoid larger necrotic lesions, eventually evolving in scarring sequelae.
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Affiliation(s)
- Paola Muggeo
- From the Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari
| | - Daniele Zama
- Paediatric Oncology and Haematology Unit "Lalla Seràgnoli", Department of Paediatrics, University of Bologna, Sant'Orsola Malpighi Hospital, Bologna
| | - Nunzia Decembrino
- Pediatric Hematology Oncology, IRCCS Policlinico San Matteo, University of Pavia
- Terapia Intensiva Neonatale, AOU Policlinico "G. Rodolico-San Marco", Catania
| | - Daniela Onofrillo
- UOS di Oncoematologia Pediatrica, Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Ospedale Spirito Santo, Pescara
| | | | - Antonella Colombini
- Pediatric Hemato-Oncology, Fondazione MBBM, Milano Bicocca University, San Gerardo Hospital, Monza
| | - Katia Perruccio
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria, Ospedale Santa Maria della Misericordia, Perugia
| | - Elisabetta Calore
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova
| | - Nagua Giurici
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste
| | - Monica Ficara
- Scuola di Specializzazione in Pediatria, Università degli Studi di Modena e Reggio Emilia; SC di Oncoematologia Pediatrica, AOU Policlinico di Modena
| | - Milena La Spina
- Centro di Riferimento Regionale di Ematologia ed Oncologia Pediatrica, AOU Policlinico "G. Rodolico-San Marco", Catania
| | - Rosamaria Mura
- Oncoematologia Pediatrica e Patologia della Coagulazione, Ospedale Pediatrico Microcitemico "Antonio Cao", AO Brotzu, Cagliari
| | - Raffaella De Santis
- UOC Oncoematoogia Pediatrica, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - Nicola Santoro
- From the Pediatric Oncology and Hematology, University Hospital of Policlinico, Bari
| | - Simone Cesaro
- Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Policlinico "G.B: Rossi", Verona, Italy
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29
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Gkoufa A, Sklapani P, Trakas N, Georgakopoulou VE. A Challenging Cutaneous Lesion in a Patient With Chronic Idiopathic Neutropenia. Cureus 2022; 14:e21225. [PMID: 35186525 PMCID: PMC8844289 DOI: 10.7759/cureus.21225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 12/02/2022] Open
Abstract
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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30
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Jamal A, Saleem A, Rezwan F, Sheikh A, Shamsi T. Successful management of colistin- and carbapenem-resistant Klebsiella pneumoniae-associated ecthyma gangrenosum in acute myeloid leukemia: A rare complication. SAGE Open Med Case Rep 2022; 10:2050313X221102113. [PMID: 35655712 PMCID: PMC9152185 DOI: 10.1177/2050313x221102113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/02/2022] [Indexed: 11/17/2022] Open
Abstract
Pseudomonal ecthyma gangrenosum is a well-known condition in immunosuppressed patients. However, ecthyma gangrenosum associated with Klebsiella pneumoniae is a rare entity that requires early recognition and optimal antibiotic and surgical management. We herein report the first case of colistin & carbapenem-resistant Klebsiella pneumoniae ecthyma gangrenosum in an acute myeloid leukemia patient. A 30-year-old female with acute myeloid leukemia received induction chemotherapy at the National Institute of Blood Diseases and Bone Marrow Transplantation hospital. Post-chemotherapy, she developed fever and a necrotic erythematous papule on right forearm. Colistin-susceptible carbapenem-resistant Klebsiella pneumoniae was isolated in cultures. Susceptibility testing was performed by microbroth dilution method. Worsening necrotic lesion prompted surgical debridement. Histopathology of debrided tissue revealed necrotic inflammation, and tissue cultures grew colistin-resistant carbapenem-resistant Klebsiella pneumoniae (colistin minimum inhibitory concentration >4 µg/mL). We speculate that colistin resistance was acquired due to impaired antibiotic penetration in necrotic nidus. A higher incidence of carbapenem-resistant Klebsiella pneumoniae-associated ecthyma gangrenosum is anticipated in hem-oncology patients, and timely diagnosis, appropriate antibiotics, and surgical debridement remain the only potential cure.
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Affiliation(s)
- Aisha Jamal
- Department of Clinical Haematology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Ali Saleem
- Department of Clinical Haematology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Faiza Rezwan
- Department of Clinical Haematology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Affaf Sheikh
- Department of Research & Development, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Tahir Shamsi
- Department of Clinical Haematology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
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31
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Krishnan N, Sheffield S, Arcinegas A, Vaghaiwalla Z, Kaeley G. A Rare Case of Ecthyma Gangrenosum. J Clin Rheumatol 2021; 27:S855. [PMID: 32084072 DOI: 10.1097/rhu.0000000000001338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Ruiz-Sanchez D, Valtueña J, Garabito Solovera E, Martinez Garcia G. Ecthyma gangrenosum, beyond Pseudomonas aeruginosa. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2021; 39:526-527. [PMID: 34565713 DOI: 10.1016/j.eimce.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/27/2020] [Indexed: 06/13/2023]
Affiliation(s)
- Daniel Ruiz-Sanchez
- Servicio de Dermatología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
| | - Jara Valtueña
- Servicio de Dermatología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Gerardo Martinez Garcia
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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33
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Kanno K, Cho Y, Fujii S, Ami Y, Nishizeki O, Sonoda M, Ishimura M, Fujiwara N. Ecthyma Gangrenosum in an Infant with Interleukin-1 Receptor-Associated Kinase 4 Deficiency. J Pediatr 2021; 239:241-242. [PMID: 34400209 DOI: 10.1016/j.jpeds.2021.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/09/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Koji Kanno
- Division of Pediatric Critical Care Medicine, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center; Department of Clinical Research and Quality Management, University of the Ryukyus Graduate School of Medicine, Okinawa, Japan
| | - Yoshiaki Cho
- Division of Pediatric Infectious Diseases, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
| | - Shuichi Fujii
- Division of Pediatric Critical Care Medicine, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
| | - Yuki Ami
- Division of Pediatric Critical Care Medicine, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
| | - Osamu Nishizeki
- Department of Plastic and Reconstructive Surgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
| | - Motoshi Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masataka Ishimura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoki Fujiwara
- Division of Pediatric Critical Care Medicine, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
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34
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Kadden D, Fowler G, Engel E, Logan C, Marathe K, Gosdin C. Streptococcal pneumonia meningitis as an initial presentation of X-linked agammaglobulinemia: A case report and discussion. J Am Coll Emerg Physicians Open 2021; 2:e12553. [PMID: 34568871 PMCID: PMC8448482 DOI: 10.1002/emp2.12553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
X-linked agammaglobulinemia (XLA) is a primary immunodeficiency caused by mutations in the gene for Bruton's tyrosine kinase (Btk), with affected males most commonly presenting with recurrent bacterial infections during the first few years of life. Here we present a 17-month-old male with a chief complaint of worsening rash and fever, whose history of streptococcal pneumonia meningitis at 5 months of age prompted suspicion for an underlying immunodeficiency and subsequent diagnosis of XLA. Bacterial meningitis is a rare initial presentation of XLA, and therefore physicians may easily overlook any underlying immunodeficiency. Prompt workup for immunodeficiency should be initiated in any vaccinated patient with a history of pneumococcal meningitis outside of the newborn period. Further discussion surrounding the various presentations of XLA, their related clinical manifestations and laboratory findings, and the importance of thorough chart review may encourage earlier diagnosis and initiation of treatment of this disease.
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Affiliation(s)
- Daniel Kadden
- UC College of Medicine, Department of PediatricsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Grace Fowler
- UC College of Medicine, Department of PediatricsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Elissa Engel
- UC College of Medicine, Department of PediatricsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Casey Logan
- UC College of Medicine, Department of PediatricsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Kalyani Marathe
- UC College of Medicine, Department of PediatricsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Craig Gosdin
- UC College of Medicine, Department of PediatricsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
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35
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Deguchi R, Nakagawa H. Advanced Ecthyma Gangrenosum with Pseudomonas aeruginosa. Intern Med 2021; 60:3187. [PMID: 33867386 PMCID: PMC8545636 DOI: 10.2169/internalmedicine.6300-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ryo Deguchi
- Department of Critical Care Medicine, Osaka City General Hospital, Japan
| | - Hidenori Nakagawa
- Department of Infectious Disease Medicine, Osaka City General Hospital, Japan
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36
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Ganesh N, Kasick R, Graham E. An Ulcerating Perineal Rash in an 8-month-old Girl. Pediatr Rev 2021; 42:155-159. [PMID: 34470898 DOI: 10.1542/pir.2020-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Nisha Ganesh
- The Ohio State University College of Medicine, Columbus, OH
| | - Rena Kasick
- The Ohio State University College of Medicine, Columbus, OH.,Nationwide Children's Hospital, Columbus, OH
| | - Emily Graham
- The Ohio State University College of Medicine, Columbus, OH.,Nationwide Children's Hospital, Columbus, OH.,The Ohio State University Wexner Medical Center, Columbus, OH
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37
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Abstract
PURPOSE OF REVIEW Pseudomonas aeruginosa is an opportunistic pathogen with considerable morbidity and mortality, particularly in vulnerable hosts. Skin manifestations are common, either representing local inoculation or secondary skin seeding following bloodstream infections. As patients with various predisposing conditions are expanding, we sought to review the most recent published evidence regarding epidemiology, risk factors and diagnosis of skin manifestations of P. aeruginosa. RECENT FINDINGS New data exist on epidemiology and diagnosis of skin infections; systemic infections are impacted by multidrug-resistance issues and host immune status. SUMMARY Green nail syndrome, toe web infection, hot tub folliculitis, hot hand-foot infection and external otitis are the most common infections originating from the skin per se. Local treatments are the cornerstone and prognosis is favorable in immunocompetent hosts. Ecthyma gangrenosum and P. aeruginosa subcutaneous nodules are usually associated with bloodstream infections and occur primarily in immunocompromised hosts. Necrotizing skin and soft tissue infections occur in diabetic, alcoholic and immunocompromised patients; management requires a multidisciplinary team with surgical approach. Burn wound infections may also be challenging, requiring a specialized team. In all the four latter types of P. aeruginosa skin infections portending significant morbidity and mortality, systemic antibiotics are an integral part of the treatment.
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38
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Mir-Bonafé JF, Mir-Bonafé M, Mir-Bonafé JM, Piquero-Casals J, Rozas-Muñoz E. Blue Toe in an Oncological Patient: Answer. Am J Dermatopathol 2021; 43:530-531. [PMID: 34140441 DOI: 10.1097/dad.0000000000001702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Juan F Mir-Bonafé
- Department of Dermatology, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - Marc Mir-Bonafé
- Department of Dermatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - José M Mir-Bonafé
- Department of Dermatology, Clínica Juaneda, Palma de Mallorca, Spain
| | - Jaime Piquero-Casals
- Department of Dermatology, Clínica dermatológica multidisciplinar Dermik, Barcelona, Spain ; and
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39
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Hadano Y, Yoshida-Sakai N, Imamura Y, Inoue T, Koga H. Acute myeloid leukaemia presenting with ecthyma gangrenosum as the first manifestation: A case report. Medicine (Baltimore) 2021; 100:e25867. [PMID: 33951001 PMCID: PMC8104150 DOI: 10.1097/md.0000000000025867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/21/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Ecthyma gangrenosum (EG) is an uncommon cutaneous infection usually associated with Pseudomonas aeruginosa bacteremia in immunocompromised patients, particularly those with underlying malignant diseases. Despite its rarity, especially in immunocompetent or nondiagnosed immunodeficiency patients, EG can present as the first manifestation of an underlying immunosuppression. PATIENT CONCERNS A 42-year-old Japanese man was admitted to our hospital with a 3-day history of a painless red macule on his right forearm and fever. DIAGNOSES Blood culture on admission revealed the presence of Pseudomonas aeruginosa, whereas pus culture of the skin lesion showed Pseudomonas aeruginosa and methicillin-susceptible Staphylococcus aureus positivity. INTERVENTIONS Additional bone marrow aspirate examination and immunophenotyping were performed to confirm the diagnosis of acute promyelocytic leukaemia with PML-retinoic acid alpha receptor. OUTCOMES The patient was successfully treated with a 14-day course of antibiotics, and no evidence of relapse was noted. The patient achieved complete remission after treatment for acute promyelocytic leukaemia. LESSONS It should be kept in mind that EG is an important cutaneous infection that is typically associated with P aeruginosa bacteremia and the presence of underlying immunodeficiency, such as acute leukaemia.
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Affiliation(s)
- Yoshiro Hadano
- Department of Infectious Diseases, St. Mary's Hospital
- Biostatistics Center, Kurume University School of Medicine
| | | | | | - Tomohiro Inoue
- Department of Emergency Medicine, St. Mary's Hospital, Kurume, Japan
| | - Hitoshi Koga
- Department of Emergency Medicine, St. Mary's Hospital, Kurume, Japan
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40
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Wong LL, Borda LJ, Liem T, Keller JJ, Ortega-Loayza AG, Jung E. Atypical Pyoderma Gangrenosum in the Setting of Venous and Arterial Insufficiency. INT J LOW EXTR WOUND 2021; 22:418-422. [PMID: 33913352 DOI: 10.1177/15347346211002334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ulcers of mixed etiology are diagnostically elusive and challenging to treat, especially when rare conditions are superimposed. Pyoderma gangrenosum (PG) is an autoinflammatory, ulcerative skin disease that is difficult to diagnose. Diagnostic criteria exist but there are no specific clinical tests to identify it. We discuss a case of PG initially diagnosed as venous ulcer in the setting of peripheral artery disease, complicated by superinfection, refractory to standard wound care, multiple surgical debridements, revascularization, negative pressure therapy, and parenteral antibiotics. Findings differentiating PG from other wound etiologies are explored, with the aim of improving clinical recognition of this condition.
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Affiliation(s)
- Lulu L Wong
- 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Luis J Borda
- 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Timothy Liem
- 6684Oregon Health & Science University, Portland, OR, USA
| | - Jesse J Keller
- 6684Oregon Health & Science University, Portland, OR, USA
| | | | - Enjae Jung
- 6684Oregon Health & Science University, Portland, OR, USA
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41
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Wiedemann GM, Schneider J, Verbeek M, Konukiewitz B, Spinner CD, Einwächter H, Schmid RM, Rothe K. An Eschar-like souvenir from a journey to Colombia: Ecthyma gangrenosum as a differential diagnosis of tropical diseases in immunocompromised patients - a case report. BMC Infect Dis 2021; 21:344. [PMID: 33845789 PMCID: PMC8042936 DOI: 10.1186/s12879-021-05998-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/18/2021] [Indexed: 11/28/2022] Open
Abstract
Background Ecthyma gangrenosum (EG) is a cutaneous infectious disease characterized by eschar-like skin ulcers typically caused by Pseudomonas aeruginosa. Here, we report a case of relapsing EG in a patient who had returned from a trip to Colombia, thus establishing EG as an important differential diagnosis of tropical diseases, and demonstrating that even long-term antibiotic treatment can result in only partial remission of EG. Case presentation A 77-year-old man with underlying chronic lymphocytic leukemia (CLL) on ibrutinib treatment was admitted because of a superinfected mosquito bite on the left ear and multiple partially necrotic skin lesions disseminated all over the entire body five days after returning from a trip to Colombia. The initial clinical suspicion of a tropical disease (leishmaniosis, systemic mycosis, or others) could not be confirmed. During the diagnostic workup, microbiological cultures of the skin biopsies and bronchoalveolar lavage revealed Pseudomonas aeruginosa, leading to a diagnosis of EG. Initial antibiotic treatment resulted in partial remission. However, the patient had to be re-admitted due to a relapse 3–4 weeks after the first episode. Finally, the patient was successfully treated with a combined approach consisting of antibiotics, recurrent surgical incisions, and administration of immunoglobulins. Conclusions In conclusion, EG should be considered as a differential diagnosis in immunosuppressed patients presenting with eschar-like skin ulcers. A combined treatment approach seems to be the best choice to achieve clinical cure and avoid relapse.
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Affiliation(s)
- Gabriela M Wiedemann
- Department of Internal Medicine II, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
| | - Jochen Schneider
- Department of Internal Medicine II, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Mareike Verbeek
- Department of Internal Medicine III, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Björn Konukiewitz
- Institute of Pathology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Christoph D Spinner
- Department of Internal Medicine II, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Henrik Einwächter
- Department of Internal Medicine II, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, University hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Kathrin Rothe
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany.,Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, School of Medicine, Munich, Germany
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42
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Russomanno K, Cardis M, Kirkorian AY. Ecthyma gangrenosum: The critical role of biofilms and other mechanisms of antibiotic resistance and implications for management. Pediatr Dermatol 2021; 38:458-460. [PMID: 33389781 DOI: 10.1111/pde.14496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/14/2020] [Accepted: 12/06/2020] [Indexed: 11/29/2022]
Abstract
Ecthyma gangrenosum is a rare cutaneous infection that occurs classically in immunocompromised patients with Pseudomonas aeruginosa bacteremia and is associated with a high mortality rate. Causative pathogens may exhibit various antibiotic evasion mechanisms, and thus, treatment may be challenging. We present a case of ecthyma gangrenosum in association with an implantable port in which cultures confirmed ten unique strains of Pseudomonas aeruginosa, highlighting the ability of this pathogen to form biofilms, rapidly mutate and ultimately evade antibiotic therapy. Dermatologists play a key role in the prompt diagnosis of this life-threatening condition, and a thorough understanding of pathogenic mechanisms is critical in selecting an efficacious treatment regimen.
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Affiliation(s)
- Kristen Russomanno
- Department of Dermatology, Medstar Georgetown University Hospital/Medstar Washington Hospital Center, Washington, DC, USA.,Department of Internal Medicine, Medstar Washington Hospital Center, Washington, DC, USA
| | - Michael Cardis
- Department of Dermatology, Medstar Georgetown University Hospital/Medstar Washington Hospital Center, Washington, DC, USA
| | - Anna Yasmine Kirkorian
- Division of Dermatology, Children's National Hospital, Washington, DC, USA.,George Washington University School of Medicine & Health Sciences, Washington, DC, USA
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43
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Ishihara T, Ozawa H. Ecthyma gangrenosum mimicking cellulitis. Clin Case Rep 2021; 9:1787-1788. [PMID: 33768939 PMCID: PMC7981716 DOI: 10.1002/ccr3.3711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/07/2020] [Accepted: 12/12/2020] [Indexed: 11/25/2022] Open
Abstract
This report has strong implications for carefully examining the common skin signs of cancer patients receiving chemotherapy. These signs can warn clinicians of the potential for severe infections such as fatal sepsis.
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Affiliation(s)
- Toru Ishihara
- Division of General Internal MedicineTokai University School of MedicineIseharaJapan
| | - Hideki Ozawa
- Division of General Internal MedicineTokai University School of MedicineIseharaJapan
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44
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Watkins RR, David MZ. Approach to the Patient with a Skin and Soft Tissue Infection. Infect Dis Clin North Am 2021; 35:1-48. [PMID: 33494872 DOI: 10.1016/j.idc.2020.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The diagnosis of a skin and soft tissue infection (SSTI) requires careful attention to a patient's history, physical examination, and diagnostic test results. We review for many bacterial, viral, fungal, and parasitic pathogens that cause SSTIs the clues for reaching a diagnosis, including reported past medical history, hobbies and behaviors, travel, insect bites, exposure to other people and to animals, environmental exposures to water, soil, or sand, as well as the anatomic site of skin lesions, their morphology on examination, and their evolution over time. Laboratory and radiographic tests are discussed that may be used to confirm a specific diagnosis.
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Affiliation(s)
- Richard R Watkins
- Division of Infectious Diseases, Cleveland Clinic Akron General, 224 West Exchange Street, Akron, OH 44302, USA; Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Michael Z David
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Blockley Hall 707, Philadelphia, PA 19104, USA; Department of Epidemiology, Biostatistics and Informatics, University of Pennsylvania, Philadelphia, PA, USA.
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45
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Answer to March 2021 Photo Quiz. J Clin Microbiol 2021; 59:59/3/e00119-20. [PMID: 33826526 DOI: 10.1128/jcm.00119-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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46
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Ulpiano Trillig A, Miendje Deyi VY, Youatou P, Konopnicki D. Echtyma gangrenosum caused by coinfection with group A Streptococcus and Staphylococcus aureus: an emerging etiology? Case reports and literature review. Acta Clin Belg 2021; 76:53-57. [PMID: 31210583 DOI: 10.1080/17843286.2019.1630570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ecthyma gangrenosum (EG) is a potentially lethal skin infection, most commonly due to Pseudomonas aeruginosa with bacteremic dissemination and affecting mostly immunocompromised patients. We present two cases of EG in two men in Belgium recently admitted to our hospital, caused by a suspected coinfection by group A Streptococcus and Staphylococcus aureus, with a cutaneous dissemination, in which multiple impetigo lesions were the portal of entry. The first patient had no risk factors nor immunodeficiency, but the second was a homeless man with drug and alcohol abuse and advanced HIV infection. Early management of the condition is crucial, with initial broad spectrum antibiotherapy, rapidly narrowed down to the germs identified and skin lesion debridement if necessary. Any immunocompromising condition must be ruled out in any patient suffering from EG.
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Affiliation(s)
- Antonio Ulpiano Trillig
- Emergency Department, Saint-Pierre-University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Pierre Youatou
- Emergency Department, Saint-Pierre-University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Deborah Konopnicki
- Infectious Diseases Department, Saint-Pierre-University Hospital, Université Libre de Bruxelles, Belgium
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47
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Saling C, Feller F, Vikram HR. Ibrutinib-associated necrotic nasal lesion and pulmonary infiltrates. BMJ Case Rep 2021; 14:14/1/e237085. [PMID: 33468501 PMCID: PMC7817807 DOI: 10.1136/bcr-2020-237085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Herein, we report a case of a 68-year-old woman receiving ibrutinib for chronic lymphocytic leukaemia, who presented with septic shock and a progressive necrotic lesion on her nose. Surgical pathology of the nasal lesion revealed evidence of tissue necrosis, and both tissue and blood culture grew Pseudomonas aeruginosa A diagnosis of ecthyma gangrenosum was made. Additional investigations also led to the discovery of invasive pulmonary aspergillosis. To our knowledge, this is the first case of ecthyma gangrenosum secondary to Pseudomonas sepsis and concurrent invasive pulmonary aspergillosis associated with ibrutinib use.
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Affiliation(s)
| | - Fionna Feller
- Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
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48
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Ruiz-Sanchez D, Valtueña J, Garabito Solovera E, Martínez García G. Ecthyma gangrenosum, beyond Pseudomonas aeruginosa. Enferm Infecc Microbiol Clin 2021; 39:S0213-005X(20)30419-5. [PMID: 33441243 DOI: 10.1016/j.eimc.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Daniel Ruiz-Sanchez
- Servicio de Dermatología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - Jara Valtueña
- Servicio de Dermatología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | | | - Gerardo Martínez García
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valladolid, Valladolid, España
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49
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Clinical and Histopathologic Characteristics of the Main Causes of Vascular Occusion — Part I: Thrombi. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2020.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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50
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Shah S, Shelburne S. Skin and Soft Tissue Infections in Non-Human Immunodeficiency Virus Immunocompromised Hosts. Infect Dis Clin North Am 2020; 35:199-217. [PMID: 33303336 DOI: 10.1016/j.idc.2020.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Skin and soft tissue infections among the non-human immunodeficiency virus infected immunosuppressed population are a serious and growing concern. Many pathogens can cause cutaneous infections in these patients owing to the highly varied and profound immune deficits. Although patients can be infected by typical organisms, the diversity and antimicrobial-resistant nature of the organisms causing these infections result in significant morbidity and mortality. The diagnostic approach to these infections in immunocompromised hosts can differ dramatically depending on the potential causative organisms. An understanding of new immunosuppressive treatments and evolving antimicrobial resistance patterns are required to optimally manage these difficult cases.
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Affiliation(s)
- Shivan Shah
- Department of Infectious Diseases, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 1460, Houston, TX 77030, USA
| | - Samuel Shelburne
- Department of Infectious Diseases, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 1460, Houston, TX 77030, USA.
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