ECTHYMA GANGRENOSUM

By Gary M. White, MD

Ecthyma gangrenosum Necrotic skin in the groin of an ICU patient with pseudomonas sepsis.


Ecthyma gangrenosum (EG) represents infection of the skin by Pseudomonas aeruginosa. Bacterial sepsis is frequent. EG is usually seen in immunocompromised patients with leukemia, lymphoma, other malignant diseases, severe burns, organ transplants, or in people receiving immunosuppressive therapy. Rarely, EG may occur in a previously healthy patient without any of the unrecognized risk factors.

Clinical

Typical lesions start out as painless erythematous macules that progress to hemorrhagic bulla and finally form the characteristic black, necrotic eschars. The axilla and groin are typical sites. Infants may rarely develop this condition in the diaper area. Skin and blood cultures may be positive for Pseudomonas. Occasionally, other bacteria are found, e.g. Streptococcus, Aeromonas hydrophila, Staphylococcus aureus, Serratia marcescens, Pseudomonas maltophilia, Citrobacter freundii, E. coli, Candida albicans, Aspergillus species, and Mucor species.

Treatment

Intravenous antibiotics appropriate for pseudomonas along with local wound debridement and skin care are essential. The prognosis is often not good. Since other organisms may present in the same manner, a broad coverage may be necessary until cultures direct therapy.

Additional Pictures

This infant had necrotic wounds that were debrided.
Ecthyma gangrenosum

References

Primary ecthyma gangrenosum as a presenting sign of leukemia in a child. Dermatology Online Journal 18(3)

An 8 month old boy. Virtual Grand Rounds

Indian Dermatol Online J 2015;6:336-8

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