Ecthyma gangrenosum: a rare cutaneous manifestation of a potentially fatal disease

Pseudomonas aeruginosa sepsis presenting as oral ecthyma gangrenosum in identical twins with Bruton tyrosine kinase gene mutation: Two case reports and review of the literature

X-linked agammaglobulinemia (XLA) is a primary immunodeficiency disease. We reported two 7-month-old identical male twins with Pseudomonas aeruginosa sepsis who initially manifested as oral ecthyma gangrenosum and were finally diagnosed to have XLA. In both cases, we confirmed the c.862C > T BTK missense mutation in exon 10 at the SH2 domain.

Aggressive necrotizing pseudomonal sinonasal infections

BACKGROUND

Pseudomonas aeruginosa is a gram-negative bacterium frequently implicated in recalcitrant sinonasal infections, especially in immunocompromised hosts. We report 6 cases of rapidly progressive pseudomonal acute rhinosinusitis producing tissue necrosis and, in certain cases, cranial nerve palsies.

METHODS

Retrospective review of 6 patients with aggressive necrotizing sinonasal infections treated at 4 tertiary academic medical centers with sinonasal cultures growing P. aeruginosa in the absence of other pathology.

RESULTS

A total of 6 patients were identified. In all cases, there was tissue necrosis that appeared to mimic an invasive process such as mucormycosis, prompting urgent surgical intervention. Pathologic analysis revealed fibropurulent exudates in backgrounds of positive P. aeruginosa cultures without evidence of invasive fungal organisms or malignancy. Four of the 6 patients presented with cranial nerve palsies, with 3 patients having vision changes and 3 complaining of trigeminal neuropathy. Four of 6 patients improved clinically over time after surgery and antibiotic therapy; 1 remains in follow-up without complete improvement and 1 has succumbed to other causes.

CONCLUSION

P. aeruginosa is a tenacious organism that is frequently associated with severe, recalcitrant sinonasal infections. We report the first case series of necrotizing sinonasal infections caused by this organism, and illustrate that, in rare cases, P. aeruginosa may mimic and behave like life-threatening conditions such as fulminant invasive fungal sinusitis or malignancy.

An Extraordinary Cause of the Sucking Difficulty: Ecthyma Gangrenosum

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.

Ecthyma Gangrenosum in a Newborn Causing External Otitis with Complete Facial Nerve Palsy

Background:

Ecthyma gangrenosum (EG) involving the external ear canal is an unusual presentation.

Objective:

To describe a case of EG diagnosed in a 5-day-old female who was admitted to our institute with multiple soft-tissue lesions involving the right arm, forearm, back, and perineum and with a complete facial palsy associated with ipsilateral external otitis.

Results:

The patient presented neonatal sepsis associated with significant leucopenia, thrombocytopenia and alteration of the coagulation profile. Microbiological analysis was performed on the purulent otorrhea and on the exudate material collected at the level of the genital lesion; both of these specimens tested positive for the presence of Pseudomonas aeruginosa. An intravenous antibiotic treatment was administered and a rapid improvement from the infection was observed.

Conclusion:

The rare occurrence of this presentation, combined with the potential for fatal complications from EG if not swiftly diagnosed underline the importance of this case.

Ecthyma gangrenosum of a single limb

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.

Pseudomonas skin infection: clinical features, epidemiology, and management

Pseudomonas aeruginosa is a Gram-negative bacillus that is most frequently associated with opportunistic infection, but which can also present in the otherwise healthy patient. The range of P. aeruginosa infections varies from localized infections of the skin to life-threatening systemic disease. Many P. aeruginosa infections are marked by characteristic cutaneous manifestations. The aim of this article is to provide a comprehensive synthesis of the current knowledge of cutaneous manifestations of P. aeruginosa infection with specific emphasis on clinical features and management. The ability of P. aeruginosa to rapidly acquire antibacterial resistance is an increasingly well recognized phenomenon, and the correct application of antipseudomonal therapy is therefore of the utmost importance. A detailed discussion of currently available anti-pseudomonal agents is included, and the benefits of antimicrobial combination therapy versus monotherapy are explored. Rapid clinical recognition of P. aeruginosa infection aided by the identification of characteristic cutaneous manifestations can play a critical role in the successful management of potentially life-threatening disease.

Ecthyma Gangrenosum Mimicking Acute Invasive Fungal Sinusitis in an Immunocompromised Patient

Ecthyma gangrenosum is a rare necrotizing cutaneous infection usually caused by Pseudomonas aeruginosa. We report a case of ecthyma gangrenosum presenting as a sinonasal eschar and mimicking acute invasive fungal sinusitis in an immunocompromised 39-year-old man with a hematologic malignancy To the best of our knowledge, this represents the first case of ecthyma gangrenosum affecting the sinonasal mucosa to he reported in the literature.

Ecthyma Gangrenosum: A Rare Cutaneous Manifestation Caused by Stenotrophomonas maltophilia in a Leukemic Patient

Ecthyma gangrenosum (EG) is a well-recognized cutaneous infection that most commonly affects immunocompromised patients. It typically occurs on the extremities, or in gluteal and perineal regions. Although Pseudomonas aeruginosa is the most well-known pathogen causing EG, other organisms have been reported to cause EG. Herein we report a rare case of ecthyma gangrenosum presenting as aggressive necrotic skin lesions in perioral and infraorbital areas in a 47-year-old patient with acute myelocytic leukemia after allogeneic bone marrow transplantation. It was caused by Stenotrophomonas maltophilia, which is an aerobic, gram-negative pathogen that has been associated only rarely with cutaneous disease. Blood culture and tissue culture were positive for S. maltophilia. Histological examination revealed numerous tiny bacilli in the dermis and perivascular area. Early recognition of skin lesions caused by S. maltophilia is important to decrease associated mortality in immunosuppressed patients.

Ecthyma gangrenosum in a non-neutropaenic, elderly patient: case report and review of the literature

Ecthyma gangrenosum is a cutaneous infection most commonly associated with Pseudomonas aeruginosa bacteraemia, but it may also be encountered after breakdown of mechanical defence barriers and local infection. The characteristic lesions of ecthyma gangrenosum are haemorrhagic blisters with surrounding erythema that rapidly evolve to necrotic ulcers. A high mortality rate is reported, especially when diagnosis is delayed and in the absence of appropriate therapy. Ecthyma gangrenosum usually occurs in critically ill and immunocompromised patients. Haematological malignancies and neutropaenia are the major risk factors, but other comorbidities (e.g. diabetes mellitus and malnutrition) have also been involved. Here, we report a case of ecthyma gangrenosum in a non-neutropaenic elderly patient with multiple comorbidities and review the literature on ecthyma gangrenosum.