Staphylococcus aureus can cause exfoliative skin conditions, ranging from localized bullous impetigo (BI) to staphylococcal scalded skin syndrome (SSSS). The latter is a potentially life-threatening disorder, which leads to blistering of the upper layer of the skin, by the release of a circulating exotoxin. The disease especially affects infants and small children but has also been described in adults. SSSS usually presents with a prodrome of sore throat or conjunctivitis. The infection is often peri-facial impetigo, here is usually no bacteremia. Bullous impetigo, the toxin produces blisters locally at the site of infection, whereas in cases of the scalded-skin syndrome, it circulates throughout the body, causing blisters at sites distant from the infection.

Ecthyma gangrenosum (EG) is a cutaneous infection most commonly associated with Pseudomonas bacteremia and usually occurring in immunocompromised patients [1]. The infection progresses sequentially from a maculopapular rash to hemorrhagic bullae, then to necrotic ulcerations with surrounding erythema [2]. Herein, we report a case of ecthyma gangrenosum in an immunologically compromised patient. A 65-year-old female was admitted to the oncohematology department for febrile pancytopenia. Blood work revealed severe thrombocytopenia at 15,000/mm³), an absolute neutrophil count of 180 cells/mm³, and anemia. A sternal bone marrow puncture found 15% of plasma cells. Four days after the admission, the patient had a painful, quickly extending lesion on the abdomen. She described erythema that progressed to pustules, then ulcerations. On general clinical evaluation, the patient was feverish at 40°C. A dermatological examination revealed the presence of a 6 cm purpuric patch on the left flank with a central necrotic eschar (Fig. 1). The diagnosis of ecthyma gangrenosum was reached and the patient was treated with ceftazidime and vancomycin. Unfortunately, having gone into septic shock, the patient died one week later.