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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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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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3
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Beato Merino MJ, Diago A, Fernández-Flores Á, Fraga J, García Herrera A, Garrido M, Idoate Gastearena MÁ, Llamas-Velasco M, Monteagudo C, Onrubia J, Pérez-González YC, Pérez Muñoz N, Ríos-Martín JJ, Ríos-Viñuela E, Rodríguez Peralto JL, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz Á, Saus C, Suárez Peñaranda JM, Velasco Benito V. Clinical and Histopathologic Characteristics of the Main Causes of Vascular Occlusion - Part I: Thrombi. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:1-13. [PMID: 33045208 PMCID: PMC7546665 DOI: 10.1016/j.ad.2020.09.006] [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: 09/20/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022] Open
Abstract
La patología vascular oclusiva es causante de diversas y variadas manifestaciones clínicas, algunas de las cuales son de catastróficas consecuencias para el paciente. Sin embargo, las causas de tal oclusión son muy variadas, extendiéndose desde trombos por acción descontrolada de los mecanismos de coagulación, hasta anomalías de los endotelios de los vasos u oclusión por materiales extrínsecos. En una serie de dos artículos hacemos una revisión de las principales causas de oclusión vascular, resumiendo sus manifestaciones clínicas principales y los hallazgos histopatológicos fundamentales. Esta primera parte corresponde a las oclusiones vasculares que cursan con trombos.
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Affiliation(s)
- M J Beato Merino
- Servicio de Anatomía Patológica, Hospital Universitario «La Paz», Madrid, España
| | - A Diago
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Á Fernández-Flores
- Servicio de Anatomía Patológica, Hospital Universitario El Bierzo, Ponferrada, España.
| | - J Fraga
- Servicio de Anatomía Patológica, Hospital Universitario de La Princesa, Madrid, España
| | - A García Herrera
- Servicio de Anatomía Patológica, Hospital Clínic, Barcelona, España
| | - M Garrido
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Á Idoate Gastearena
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena. Departamento de Citología, Histología y Anatomía Patológica, Facultad de Medicina, Universidad de Sevilla, España
| | - M Llamas-Velasco
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España
| | - C Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia. Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - J Onrubia
- Servicio de Anatomía Patológica. Hospital Universitario San Juan de Alicante, Alicante, España
| | | | - N Pérez Muñoz
- Servicio de Anatomía Patológica. Hospital Universitari General de Catalunya. Quirónsalud, Barcelona, España
| | - J J Ríos-Martín
- Servicio de Anatomía Patológica. Hospital Universitario Virgen Macarena, Sevilla, España
| | - E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - J L Rodríguez Peralto
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - E Rozas Muñoz
- Departamento de Dermatología, Hospital de San Pablo, Coquimbo, Chile
| | - O Sanmartín
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Santonja
- Servicio de Anatomía Patológica, Fundación Jiménez Díaz, Madrid, España
| | - Á Santos-Briz
- Servicio de Anatomía Patológica, Hospital Universitario de Salamanca, Salamanca, España
| | - C Saus
- Servicio de Anatomía Patológica, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - J M Suárez Peñaranda
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Santiago, España
| | - V Velasco Benito
- Servicio de Anatomía Patológica, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
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Koumaki D, Koumaki V, Katoulis AC, Gerontitis D, Xilouri I, Krasagakis K. Ecthyma gangrenosum caused by Klebsiella pneumoniae and Streptococcus vestibularis in a patient with acute myeloid leukemia: an emerging pathogen. Int J Dermatol 2018; 58:E83-E85. [PMID: 30548464 DOI: 10.1111/ijd.14322] [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: 10/26/2018] [Revised: 11/05/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Dimitra Koumaki
- Dermatology Department, University Hospital of Heraklion, Crete, Greece
| | - Vasiliki Koumaki
- Microbiology Department, Medical School of Athens, Athens, Greece
| | | | | | - Irini Xilouri
- Haematology Department, University Hospital of Heraklion, Crete, Greece
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5
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López-Iñiguez A, Pérez-Gutiérrez MT, Lambraño-Castillo D, Sierra-Madero JG. Necrotic lesion in an immunosuppressed patient. Enferm Infecc Microbiol Clin 2017; 36:596-597. [PMID: 29132944 DOI: 10.1016/j.eimc.2017.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Alvaro López-Iñiguez
- Infectology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Ciudad de México, Mexico
| | - María Teresa Pérez-Gutiérrez
- Infectology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Ciudad de México, Mexico
| | - Darwin Lambraño-Castillo
- Infectology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Ciudad de México, Mexico
| | - Juan Gerardo Sierra-Madero
- Infectology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Ciudad de México, Mexico.
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Ceylan N, Demir N, Kocaman S, Peker E, Tuncer O. An Extraordinary Cause of the Sucking Difficulty: Ecthyma Gangrenosum. Case Rep Med 2016; 2016:8502150. [PMID: 27143976 PMCID: PMC4837260 DOI: 10.1155/2016/8502150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 03/24/2016] [Indexed: 11/18/2022] Open
Abstract
Ecthyma gangrenosum is a cutaneous lesion often associated with pseudomonas aeruginosa bacteremia, even though it may develop without bacteremia and may originate from other bacterial and fungal organisms. Pseudomonas aeruginosa bacteremia or sepsis, which mainly affects immunocompromised patients, frequently occurs in hospitals. This lesion typically occurs on the extremities and gluteal and perineal regions. In this report we present a case of ecthyma gangrenosum in a premature newborn occurring secondary to pseudomonas sepsis causing sucking dysfunction due to tissue loss in the lip, soft palate, and tongue.
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Affiliation(s)
- Nesrin Ceylan
- Department of Pediatrics, Yuzuncu Yil University School of Medicine, 65080 Van, Turkey
| | - Nihat Demir
- Department of Pediatrics, Division of Neonatology, Yuzuncu Yil University School of Medicine, 65080 Van, Turkey
| | - Selami Kocaman
- Department of Pediatrics, Yuzuncu Yil University School of Medicine, 65080 Van, Turkey
| | - Erdal Peker
- Department of Pediatrics, Division of Neonatology, Yuzuncu Yil University School of Medicine, 65080 Van, Turkey
| | - Oğuz Tuncer
- Department of Pediatrics, Division of Neonatology, Yuzuncu Yil University School of Medicine, 65080 Van, Turkey
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7
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Seront E, Kidd F, Metz T, Van Ruyssevelt P. Atypical case of ecthyma gangrenosum mimicking a breast cancer recurrence. BMJ Case Rep 2016; 2016:bcr-2016-214349. [PMID: 27030458 DOI: 10.1136/bcr-2016-214349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 68-year-old woman with a history of breast cancer presented with skin lesions and sternal pain. Clinical examination revealed ulcerative lesions on mastectomy scar and CT scan showed contiguous sternal osteolysis. The main hypothesis was a breast cancer recurrence; however, cutaneous and bone biopsies did not reveal any cancer cells. Skin tissue culture detected Pseudomonas aeruginosa, suggesting ecthyma gangrenosum despite the absence of bacteraemia in our patient and despite her immunocompetence. Surgical treatment was performed, followed by a long course of antibiotherapy.
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Affiliation(s)
- Emmanuel Seront
- Department of Medical Oncology, Hopital de Jolimont, Haine Saint Paul, Belgium
| | - François Kidd
- Department of Medical Infectiology, Hopital de Jolimont, Haine Saint Paul, Belgium
| | - Tanguy Metz
- Department of Medical Dermatology, Hopital de Jolimont, Haine Saint Paul, Belgium
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8
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Ecthyma gangrenosum in a 67-year-old man with chronic lymphocytic leukemia. J Emerg Med 2012; 43:339-41. [PMID: 22560273 DOI: 10.1016/j.jemermed.2011.09.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 09/18/2011] [Indexed: 11/21/2022]
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Abstract
Ecthyma gangrenosum is a skin manifestation of systemic sepsis commonly caused by Pseudomonas aeruginosa in patients with neutropenia or underlying immune deficiency. Although the usual outcome is poor, early recognition and appropriate systemic antibiotic treatment can lead to successful outcome. We report a case of a previously healthy lady with no apparent immune deficiency or neutropenia who had ecthyma gangrenosum of left lower limb in which the arterial line was placed.
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Affiliation(s)
- George M Varghese
- Department of Medicine and Infectious Diseases, Christian Medical College, Vellore, India
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10
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Motswaledi MH. Superficial skin infections and the use of topical and systemic antibiotics in general practice. S Afr Fam Pract (2004) 2011. [DOI: 10.1080/20786204.2011.10874073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- MH Motswaledi
- Department of Dermatology, University of Limpopo, Medunsa Campus
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11
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Delgado-Jiménez Y, Fraga J, Fernández-Herrera J, García-Diez A. [Septic vasculopathy]. ACTAS DERMO-SIFILIOGRAFICAS 2010; 98 Suppl 1:22-8. [PMID: 18093496 DOI: 10.1016/s0001-7310(07)70178-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Sepsis is one of the commonest causes of death around the world. The real frequency of cutaneous lesions in the setting of sepsis is unknown, but when they appear, they are usually one of the earliest signs of sepsis, thus allowing a rapid diagnosis of this potentially life-threatening condition. Four are the main physiopathologic mechanisms that can induce cutaneous lesions in sepsis: a) disseminated intravascular coagulation; b) direct vessel wall invasion by the microorganism; c) immune-mediated vasculitis, and d) septic embolism. We know that more than one of these mechanisms can appear in one single patient. In this review, we analyse these four mechanisms, their clinical presentation, and the histological findings that can be found in the cutaneous biopsy.
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Affiliation(s)
- Y Delgado-Jiménez
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España.
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12
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Kim HS, Lee JSS, Tang MBY. Localized ecthyma gangrenosum in patients with diabetes mellitus: Diagnosis and management. J Dermatol 2010; 37:758-61. [PMID: 20649725 DOI: 10.1111/j.1346-8138.2010.00837.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Goolamali SI, Fogo A, Killian L, Shaikh H, Brathwaite N, Ford-Adams M, Macfarlane S. Ecthyma gangrenosum: an important feature of pseudomonal sepsis in a previously well child. Clin Exp Dermatol 2009; 34:e180-2. [DOI: 10.1111/j.1365-2230.2008.03020.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Chen SC, Chang HC, Chu SJ, Wu CP, Tsai SH. Rapid evolutionary papules in a uremic patient. THE JOURNAL OF TRAUMA 2007; 63:449. [PMID: 17693851 DOI: 10.1097/01.ta.0000208191.16644.1f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Shin-Chieh Chen
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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15
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Ishikawa T, Sakurai Y, Tanaka M, Daikoku N, Ishihara T, Nakajima M, Miyagawa S, Yoshioka A. Ecthyma gangrenosum-like lesions in a healthy child after infection treated with antibiotics. Pediatr Dermatol 2005; 22:453-6. [PMID: 16191001 DOI: 10.1111/j.1525-1470.2005.00116.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ecthyma gangrenosum is a cutaneous infection associated most commonly with pseudomonal sepsis in the immunocompromised patient. We describe a previously healthy 4-year-old boy who developed ecthyma gangrenosum-like lesions secondary to antibiotic treatment for possible streptococcal infection. The skin, ears, and extremities were involved. This presentation emphasizes the importance of awareness of the rare complication of ecthyma gangrenosum-like lesions associated with non-Pseudomonas bacterial infection treated with antibiotics, even in a previously healthy child.
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Affiliation(s)
- Tomoaki Ishikawa
- Department of Pediatrics, Nara Medical University School of Medicine, Kashihara, Japan
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16
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Abstract
Pseudomonas aeruginosa bacteremia or sepsis often occurs in hospitals, affecting mainly children with underlying disease. Ecthyma gangrenosum is classically considered a pathognomonic sign of sepsis by P. aeruginosa. The harlequin baby, a severe variant of ichthyosis, occurs rarely, and these infants are at high risk of cutaneous infections and sepsis. We herein report a harlequin baby who developed ecthyma gangrenosum.
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Affiliation(s)
- Tamer Gunes
- Department of Pediatrics, Division of Neonatology, School of Medicine, Erciyes University, Kayseri, Turkey.
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Almeida JFLD, Sztajnbok J, Troster EJ, Vaz FAC. Pseudomonas aeruginosa septic shock associated with ecthyma gangrenosum in an infant with agammaglobulinemia. Rev Inst Med Trop Sao Paulo 2002; 44:167-9. [PMID: 12163911 DOI: 10.1590/s0036-46652002000300010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ecthyma gangrenosum (EG) due to Pseudomonas aeruginosa is a rare and invasive infection that can be associated with agammaglobulinemia. The cornerstone of the treatment is based on prompt recognition with appropriate antibiotic coverage and intravenous immunoglobulin. The authors report a case of EG emphasizing the clinical and therapeutic aspects of this condition.
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Abstract
Noma neonatorum was suggested as a distinct entity characterized by a gangrenous process of the nose, oral cavity, eyelids and perineum that was almost universally fatal in premature infants with Pseudomonas sepsis. We report the first case of noma neonatorum in a 26-week-gestation twin born in the United States. Our case is consistent with previous descriptions of noma neonatorum; however, we question the distinction between noma neonatorum and a neonatal presentation of ecthyma gangrenosum.
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Affiliation(s)
- Alexandra F Freeman
- Pediatric Infectious Disease Division, Children's Memorial Hospital, Northwestern University Medical School, Chicago, IL, USA
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Kim DC, Cresswell A, Mitra A. Compartment syndrome in a patient with X-linked agammaglobulinaemia and ecthyma gangrenosum. Case report. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 2000; 34:87-9. [PMID: 10756581 DOI: 10.1080/02844310050160222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Compartment syndrome is a surgical emergency that requires immediate decompression. We know of no documented cases that describe ecthyma gangrenosum as a primary cause of compartment syndrome. We present a case of a baby with x-linked agammaglobulinaemia who developed compartment syndrome associated with systemic Pseudomonas aeruginosa infection and ecthyma gangrenosum of the leg. He was treated by debridement and fasciotomies followed by primary closure and skin grafting and made an uneventful recovery.
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Affiliation(s)
- D C Kim
- Division of Plastic and Reconstructive Surgery, Temple University Hospital, Philadelphia, USA
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Abstract
Ecthyma gangrenosum is the cutaneous manifestation of Pseudomonas aeruginosa septicemia, typically affecting immunosuppressed patients, particularly those with neutropenia. Association with HIV disease has been rarely reported. We describe an unusual presentation of solitary ecthyma gangrenosum on the face of a non-neutropenic patient with AIDS.
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Affiliation(s)
- E J Kim
- Department of Dermatology, Boston University School of Medicine, Massachusetts 02118, USA
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Asumang A, Goldsmith AL, Dryden M. Subcutaneous nodules with pseudomonas septicaemia in an immunocompetent patient. Anaesth Intensive Care 1999; 27:213-5. [PMID: 10212724 DOI: 10.1177/0310057x9902700217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pseudomonas septicaemia presenting with subcutaneous nodules, though rare, is well described in immunocompromized populations. It is, however, very uncommon in immunocompetent patients. We describe a case of a 42-year-old woman who presented with community-acquired. Pseudomonas aeruginosa septicaemia and subcutaneous nodules. No precipitating cause or immune dysfunction was found. She was successfully treated with appropriate antibiotics, respiratory and cardiovascular support in the Intensive Care Unit. The difficulty in eradicating the organism from the skin lesion and the need for investigating the immune function of septicaemia patients are discussed.
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Affiliation(s)
- A Asumang
- Department of Anaesthetists, Royal Hampshire County Hospital, Hants, United Kingdom
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Affiliation(s)
- H Güçlüer
- Marmara University, School of Medicine, Department of Dermatology, Istanbul, Turkey
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Rodot S, Lacour JP, van Elslande L, Castanet J, Desruelles F, Ortonne JP. Ecthyma gangrenosum caused by Klebsiella pneumoniae. Int J Dermatol 1995; 34:216-7. [PMID: 7751103 DOI: 10.1111/j.1365-4362.1995.tb01575.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
We report our experience, and review the literature, concerning 'intensive care dermatology'. Over a period of 14 months, 27 patients who had significant cutaneous problems were seen in the intensive care unit. These included primary dermatological conditions, multisystem disorders with cutaneous signs, complications of dermatological therapy, and skin conditions developing as complications of intensive care. We discuss the diagnosis and management of dermatological problems in the intensive care unit.
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Affiliation(s)
- M G Dunnill
- St John's Institute of Dermatology, St Thomas's Hospital, London, U.K
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