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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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Wuyts L, Wojciechowski M, Maes P, Matthieu L, Lambert J, Aerts O. Juvenile ecthyma gangrenosum caused by
Pseudomonas aeruginosa
revealing an underlying neutropenia: case report and review of the literature. J Eur Acad Dermatol Venereol 2019; 33:781-785. [DOI: 10.1111/jdv.15420] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- L. Wuyts
- Department of Dermatology University Hospital Antwerp (UZA) University of Antwerp (UA) Antwerp Belgium
| | - M. Wojciechowski
- Department of Pediatrics University Hospital Antwerp (UZA) University of Antwerp (UA) Antwerp Belgium
| | - P. Maes
- Department of Pediatrics University Hospital Antwerp (UZA) University of Antwerp (UA) Antwerp Belgium
| | - L. Matthieu
- Department of Dermatology University Hospital Antwerp (UZA) University of Antwerp (UA) Antwerp Belgium
| | - J. Lambert
- Department of Dermatology University Hospital Antwerp (UZA) University of Antwerp (UA) Antwerp Belgium
| | - O. Aerts
- Department of Dermatology University Hospital Antwerp (UZA) University of Antwerp (UA) Antwerp Belgium
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Isezuo KO, Sani UM, Waziri UM, Garba BI, Mohammed Y, Legbo JF, Aquil NP, Abubakar FI, Omar M. Ecthyma gangrenosum on the face of a malnourished child with Pseudomonas sepsis: Simulating Cancrum oris. Afr J Lab Med 2018; 7:756. [PMID: 30568894 PMCID: PMC6295829 DOI: 10.4102/ajlm.v7i1.756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 09/19/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction Ecthyma gangrenosum (EG) is a cutaneous lesion commonly caused by Pseudomonas aeruginosa that involves mainly the lower limbs and gluteal region, seen more in immunosuppressed patients with neutropenia. Cancrum oris (Noma) is a gangrenous necrosis of the face that begins as a gingival ulcer and progresses rapidly to destroy contiguous tissues in malnourished children. Case Presentation This article reports a case of facial EG which was similar to Noma in a malnourished child: a 16-month old girl with fever, cough, weight loss, watery stool and swelling on right cheek. She was febrile, pale, wasted with bilateral pitting pedal oedema. She had a solitary circumscribed round necrotic lesion, with surrounding hyperaemia on the right malar area which extended to destroy the right ala nasi. No intra-oral rashes but she had left ear discharge. She received blood transfusion, antibiotics, antiseptic wound care and nutritional rehabilitation. Management and Outcome Swabs of the lesion and ear discharge both revealed Gram-negative bacilli and culture yielded P. aeruginosa. Retroviral, Mantoux and Gene Xpert tests were negative. She had moderate anaemia, normal white blood cell count, and neutropaenia. Parenteral ceftriazone was changed to ciprofloxacin based on sensitivity results and lack of clinical response. The wound healed with residual scarring and partial destruction of right ala nasi. Discussion Although this patient had facial necrosis to suggest Noma, she did not have initial oral involvement, and clinical features such as Pseudomonas sepsis and neutropaenia suggested EG. Facial necrosis in malnourished children may be due to EG.
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Affiliation(s)
- Khadijat O Isezuo
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Usman M Sani
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Usman M Waziri
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Bilkisu I Garba
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Yahaya Mohammed
- Department of Medical Microbiology and Parasitology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Joy F Legbo
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Nazish P Aquil
- Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Fatima I Abubakar
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Memuna Omar
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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Yoon JS, Kim DH, Lee SJ, Bang HH, Bae SM, Park KB, Lee SY, Jung KJ, Choi YJ, Lee HJ, Park JS. Ecthyma gangrenosum and agranulocytosis in a previously healthy 12-month-old girl: Report of 1 case with a literature review. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.4.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ji Soo Yoon
- Department of Pediatrics, Soonchunhyang Unversity College of Medicine, Cheonan, Korea
| | - Dong Hyun Kim
- Department of Pediatrics, Soonchunhyang Unversity College of Medicine, Cheonan, Korea
| | - Seung Ju Lee
- Department of Pediatrics, Soonchunhyang Unversity College of Medicine, Cheonan, Korea
| | - Hyun Ho Bang
- Department of Pediatrics, Soonchunhyang Unversity College of Medicine, Cheonan, Korea
| | - Sun Mi Bae
- Department of Pediatrics, Soonchunhyang Unversity College of Medicine, Cheonan, Korea
| | - Kyeong Bae Park
- Department of Pediatrics, Soonchunhyang Unversity College of Medicine, Cheonan, Korea
| | - Sung Yul Lee
- Department of Dermatology, Soonchunhyang Unversity College of Medicine, Cheonan, Korea
| | - Ki Jin Jung
- Department of Orthopedic Surgery, Soonchunhyang Unversity College of Medicine, Cheonan, Korea
| | - Young Jin Choi
- Department of Clinical Laboratory Medicine, Soonchunhyang Unversity College of Medicine, Cheonan, Korea
| | - Hyun Jung Lee
- Department of Emergency Medicine, Soonchunhyang Unversity College of Medicine, Cheonan, Korea
| | - Joon Soo Park
- Department of Pediatrics, Soonchunhyang Unversity College of Medicine, Cheonan, Korea
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Bhardwaj NK, Khera D, Gupta N, Singh K. Disseminated Pseudomonas aeruginosa sepsis as presenting diagnosis of X-linked agammaglobulinaemia in a previously well 16-month-old child. BMJ Case Rep 2017; 2017:bcr-2017-221006. [PMID: 28851726 DOI: 10.1136/bcr-2017-221006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
We report a previously healthy 16-month-old child who presented to us with membranous pharyngitis and ecthyma gangrenosum. In this patient, Pseudomonas aeruginosa was isolated from throat swab, cerebrospinal fluid, skin swab, urine, blood and synovial fluid in a single admission. In further workup, this child was diagnosed as a case of X-linked agammaglobulinaemia. The child was treated successfully with antipseudomonal antibiotics for 6 weeks and intravenous immunoglobulin.
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Affiliation(s)
- Naveen Kumar Bhardwaj
- Department of Pediatrics, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
| | - Daisy Khera
- Department of Pediatrics, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
| | - Neeraj Gupta
- Department of Pediatrics, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
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Biscaye S, Demonchy D, Afanetti M, Dupont A, Haas H, Tran A. Ecthyma gangrenosum, a skin manifestation of Pseudomonas aeruginosa sepsis in a previously healthy child: A case report. Medicine (Baltimore) 2017; 96:e5507. [PMID: 28079790 PMCID: PMC5266152 DOI: 10.1097/md.0000000000005507] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Ecthyma gangrenosum (Eg) is a necrotic lesion that is mostly seen in immunocompromised patients. It reflects a severe sepsis, possibly caused by Pseudomonas aeruginosa (Pa). PATIENT CONCERNS A healthy 3-year-old girl admitted to the Pediatric Emergency Department presented a sepsis-associated purpura with neurological and respiratory distress. INTERVENTIONS An empiric antibiotherapy (anti-meningococcal) was prescribed. DIAGNOSES Forty-eight hours after admission, blood and wound cultures were positive for Pa. As a result, the decision was made to change the antibiotic therapy.Unfortunately, on day 3, the patient died. Exhaustive immunologic tests are presently being carried out. OUTCOMES Eg caused by Pa is uncommon in healthy children, and purpura sepsis is usually caused by Neisseria meningitides infection. LESSONS Eg should be recognized rapidly so that the appropriate treatment can be prescribed as quickly as possible.
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Akkurt ZM, Fidan V, Uçmak D, Dal T, Kelekçi S, Uçak H. A case of perineal ecthyma gangrenosum. Turk Arch Pediatr 2016; 51:46-8. [PMID: 27103864 DOI: 10.5152/turkpediatriars.2016.1300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 07/29/2013] [Indexed: 11/22/2022]
Abstract
Ecthyma gangrenosum is a skin lesion associated with Pseudomonas aeruginosa. A previously healthy one-year-old boy who had been diagnosed with varicella 10 days ago was admitted to our hospital with complaints of diarrhea, green ear discharge and new lesions in the diaper area. Intravenous meropenem and amikacin had been previously initiated. Physical examination revealed greenish, well bordered necrotic ulcers on both gluteal areas and the perianal area. Pseudomonas aeruginosa grew in wound culture. A colostomy was opened due to recalcitrant diarrhea and ulcers. The patient remitted in one month and was discharged. T lymphocyte subgroups and immunoglobulins were found to be normal on immunologic evaluation. We presented this case to draw attention to the fact that ecthyma gangrenosum due to Pseudomonas aeruginosa may occur in the diaper area and that sepsis due to Pseudomonas should be investigated.
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Affiliation(s)
- Zeynep Meltem Akkurt
- Department of Dermatology and Veneral Diseases, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Veysi Fidan
- Department of Dermatology and Veneral Diseases, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Derya Uçmak
- Department of Dermatology and Veneral Diseases, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Tuba Dal
- Department of Microbiology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Selvi Kelekçi
- Department of Pediatrics, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Haydar Uçak
- Department of Dermatology and Veneral Diseases, Dicle University School of Medicine, Diyarbakır, Turkey
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Gargouri L, Maaloul I, Kamoun T, Maalej B, Safi F, Majdoub I, Hachicha M, Mahfoudh A. Ecthyma gangrenosum: A manifestation of community-acquired Pseudomonas aeruginosa septicemia in three infants. Arch Pediatr 2015; 22:616-20. [DOI: 10.1016/j.arcped.2015.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/06/2014] [Accepted: 03/11/2015] [Indexed: 11/16/2022]
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9
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Yin J, Li CW, Luo N, Ma JJ, Liu L, Li XJ, Du XJ, Hu J. Pseudomonas aeruginosa Sepsis Associated With Ecthyma Gangrenosum in a Previously Healthy Infant: A Case Report and Literature Review. Glob Pediatr Health 2015; 2:2333794X15591566. [PMID: 27335965 PMCID: PMC4900116 DOI: 10.1177/2333794x15591566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jing Yin
- Tianjin Children's Hospital, Tianjin, China
| | | | - Na Luo
- Nankai University, Tianjin, China
| | - Ji-Jun Ma
- Tianjin Children's Hospital, Tianjin, China
| | - Li Liu
- Tianjin Children's Hospital, Tianjin, China
| | | | | | - Jian Hu
- Tianjin Children's Hospital, Tianjin, China
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Ecthyma gangrenosum and ecthyma-like lesions: review article. Eur J Clin Microbiol Infect Dis 2014; 34:633-9. [DOI: 10.1007/s10096-014-2277-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
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