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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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2
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Ecthyma gangrenosum as a serious complication of Pseudomonas aeruginosa infection in departments of paediatric oncology. Postepy Dermatol Alergol 2021; 38:537-543. [PMID: 34658690 PMCID: PMC8501443 DOI: 10.5114/ada.2020.100747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 04/11/2020] [Indexed: 11/17/2022] Open
Abstract
In most cases ecthyma gangrenosum is a consequence of Pseudomonas aeruginosa bloodstream infection in immunodeficient patients. This bacterium is characterized by multi-drug resistance and has a number of mechanisms that allow it to survive even in extreme conditions. The disease is characterized by an aggressive course involving the skin and mucous membranes, leading to ulceration with signs of necrosis within 12 to 24 h. Treatment includes targeted antibiotic therapy and surgical cleansing of the wound. If the perianal area is occupied, a colostomy may be performed. Prevention of bacterial infections involves taking special precautions when handling a patient with immunodeficiency.
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Sharma A, Agarwal S, Sharma A, Kumar M. Varicella gangrenosum in adult: a fatal chickenpox complication. BMJ Case Rep 2019; 12:12/4/e226363. [PMID: 30948409 DOI: 10.1136/bcr-2018-226363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Varicella gangrenosum is a gangrenous ulceration of varicella lesions involving the skin and soft tissues of the body. The term was coined more than 100 years ago. This occurs due to superimposed bacterial infection. The presentation of primary varicella in adults is more severe with catastrophic systemic complications as compared with children. These complications include necrotising fasciitis, disseminated intravascular coagulation, wet/dry gangrene and death, as was seen in our case. Survival is dependent on early diagnosis and treatment. Adequate antibiotic treatment and particularly early radical surgical debridement should be the cornerstone of management. Less than 10 such cases are reported in the literature.
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Affiliation(s)
- Ashish Sharma
- Urology, King George's Medical University, Lucknow, Uttar-Pradesh, India
| | - Samarth Agarwal
- Urology, King George's Medical University, Lucknow, Uttar-Pradesh, India
| | - Anamika Sharma
- Intensive Care, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Manoj Kumar
- Urology, King George's Medical University, Lucknow, Uttar-Pradesh, India
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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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Dermatologic Conditions of the Early Post-Transplant Period in Hematopoietic Stem Cell Transplant Recipients. Am J Clin Dermatol 2019; 20:55-73. [PMID: 30298481 DOI: 10.1007/s40257-018-0391-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hematopoietic stem cell transplants (HSCTs) are used to treat a variety of conditions, including hematologic malignancies, bone marrow failure syndromes, and immunodeficiencies. Over 60,000 HSCTs are performed annually worldwide, and the numbers continue to increase. Indeed, as new conditioning regimens develop, more and more individuals, including those of older age, will be eligible for transplants. Nevertheless, although HSCTs are clearly a life-saving and necessary treatment for thousands of patients per year, there is still substantial morbidity and mortality associated with the procedure. Of note, skin eruptions in the post-HSCT period are frequent and often significantly reduce quality of life in recipients. Moreover, these cutaneous findings sometimes herald an underlying systemic condition, presenting possible opportunities for timelier intervention. Dermatologists therefore play a vital role in distinguishing life-threatening conditions from benign issues and prompting recognition of critical complications earlier in their course. This article aims to review the major dermatologic conditions occurring in the early post-HSCT period.
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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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R G S, Muralidhar V. Non-pseudomonal ecthyma gangrenosum caused by methicillin-resistant S taphylococcus aureus (MRSA) in a chronic alcoholic patient. BMJ Case Rep 2017; 2017:bcr-2017-220983. [PMID: 28775089 DOI: 10.1136/bcr-2017-220983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
We report for the first time a case of non-pseudomonal ecthyma gangrenosum (EG) caused by methicillin-resistant Staphylococcus aureus in a chronic alcoholic without an associated immunocompromised state or disease. EG is an infection of the skin, commonly associated with Pseudomonas aeruginosa bacteraemia, though other organisms are also known to be causally related. It usually occurs in patients who are terminally ill and the immunocompromised. In our case, chronic alcoholism with suppression of innate immunity may have led to the development of the condition.
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Affiliation(s)
- Santhaseelan R G
- General Surgery, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
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Moraxella lacunata Bacteremia and Sepsis Associated With Ecthyma Gangrenosum. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2017. [DOI: 10.1097/ipc.0000000000000442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Mishra K, Yanamandra U, Prakash G, Malhotra P. Ecthyma gangrenosum in a case of acute lymphoblastic lymphoma. BMJ Case Rep 2017; 2017:bcr-2016-218501. [PMID: 28052953 DOI: 10.1136/bcr-2016-218501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kundan Mishra
- Department of Internal Medicine (Clinical Hematology Division), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Uday Yanamandra
- Department of Internal Medicine (Clinical Hematology Division), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- Department of Internal Medicine (Clinical Hematology Division), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine (Clinical Hematology Division), Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Shanghai Fever: An Uncommon Manifestation of a Common Superbug. Indian J Pediatr 2016; 83:1013-4. [PMID: 27173650 DOI: 10.1007/s12098-016-2140-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
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Hizli Ş, Işikay S, Arikan Ç. Ecthyma gangrenosum in an infant after liver transplantation. Pediatr Int 2016; 58:950-2. [PMID: 27682614 DOI: 10.1111/ped.13066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 06/01/2016] [Indexed: 11/28/2022]
Abstract
Ecthyma gangrenosum is a rare, necrotizing, bacterial infection of the skin most commonly caused by Pseudomonas aeruginosa. It has a characteristic clinical picture starting with maculopapular eruption followed by hemorrhagic vesicle and evolving into gangrenous ulcer. Although direct skin inoculation without septicemia is also probable, usually ecthyma gangrenosum is pathognomonic for Pseudomonas septicemia, which has a mortality rate of 38-96%. Herein, we report on the case of a 9-month-old male infant diagnosed with ecthyma gangrenosum who had undergone liver transplantation approximately 6 months previously and who was under immunosuppressive treatment, in order to highlight the importance of the early diagnosis and treatment of this disease.
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Affiliation(s)
- Şamil Hizli
- Department of Pediatric Gastroenterology, Yıldırım Beyazıt University, Ankara, Turkey
| | - Sedat Işikay
- Department of Pediatrics, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey.
| | - Çiğdem Arikan
- Department of Pediatric Gastroenterology, Kent Hospital, İzmir, Turkey
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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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13
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Ecthyma gangrenosum of the scrotum: a case report. Front Med 2016; 10:101-3. [PMID: 26941196 DOI: 10.1007/s11684-016-0437-z] [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: 10/08/2015] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
A 43-year-old man with pancytopenia from chemotherapy for acute myeloid leukemia developed left scrotal pain, fever, and rigors. Physical exam revealed an ulcerating lesion with central necrosis and eschar surrounded by a halo of erythema on the inferior aspect of the left scrotum. The condition indicated an early necrotizing soft tissue infection. The patient was started on broad-spectrum antibiotics and taken to the operating room for a wound debridement. Blood and tissue cultures grew Pseudomonas aeruginosa, which confirmed the diagnosis of ecthyma gangrenosum of the scrotum. The fever resolved, and the wound healed without further progression after wet to dry dressing changes.
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Abstract
Ecthyma gangrenosum is a rare skin infection caused by Pseudomonas aeruginosa. It is usually seen in immunocompromised and critically ill patients. We report one such case in a previously healthy 20-year old male. Ecthyma gangrenosum can occur in healthy patients without bacteremia.
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Affiliation(s)
- Ilkay Bozkurt
- Department of Clinical Microbiology and Infectious Diseases, Ondokuz Mayis Universty, Samsun, Turkey
| | | | - Mustafa Sunbul
- Department of Clinical Microbiology and Infectious Diseases, Ondokuz Mayis Universty, Samsun, 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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Affiliation(s)
- Giada Biddeci
- Department of Woman and Child Health, Medical School, University of Padua, Padova, Italy
| | - Mario Cutrone
- Pediatric Dermatology Unit, "Ospedale Dell'Angelo", Mestre, Venezia, Italy
| | - Ilaria Mattei
- Pediatric Dermatology Unit, "Ospedale Dell'Angelo", Mestre, Venezia, Italy
| | - Enrico Valerio
- Department of Woman and Child Health, Medical School, University of Padua, Padova, Italy
| | - Francesca Favot
- Pediatric Dermatology Unit, "Ospedale Dell'Angelo", Mestre, Venezia, Italy
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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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Diagnosis and management of ecthyma gangrenosum in chronic renal failure patient. Arch Plast Surg 2014; 41:299-301. [PMID: 24883286 PMCID: PMC4037781 DOI: 10.5999/aps.2014.41.3.299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/04/2014] [Accepted: 03/04/2014] [Indexed: 11/08/2022] Open
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