No abstract

Pseudomonas aeruginosa is one of the most important causes of morbidity and mortality in immunocompromised patients, mainly in hospital settings. Ecthyma gangrenosum is a cutaneous manifestation of systemic Pseudomonas infection. Clinical presentacion is as indurated, necrotic, and painless skin lesions. This case report presents a 1-year-old male infant, with a history of biphenotypic leukemia and central nervous system infiltration, who underwent allogeneic stem cell transplantation two times, one month prior to presenting erythema and ulceration in the lower eyelid and left periorbital region; which quickly progression to tissue necrosis. Biopsy-culture and blood culture was performed, microbiological isolation and histopathological reported P. aeruginosa, managed initially with cefepime for AmpC resistance pattern, however fever flare up at 3 weeks, central line-associated bloodstream infection was diagnosed, same bacteria with new enzymatic resistance mechanism was isolated and confirmed by phenotypic test. It was approached in a multidisciplinary way by broad-spectrum systemic antibiotic ceftazidime/avibactam and surgical treatment, to eradicate the focus of infection, ensuring the functionality of the affected site.