Ecthyma gangrenosum: A manifestation of community-acquired Pseudomonas aeruginosa septicemia in three infants

Gargouri, L.; Mâaloul, I.; Kamoun, T.; Maalej, B.; Safi, Faiza; Majdoub, I.; Hachicha, M.; Mahfoudh, A.

doi:10.1016/j.arcped.2015.03.006

Cited by 23 publications

(22 citation statements)

References 16 publications

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“…11 Finally, communityacquired infections by Pseudomonas have also been described in (seemingly) healthy children, especially in newborns and in children under the age of 1 year. 6 In children suffering from EG, presenting with frequent and/or atypical infectious episodes as in the present case, but also when they appear to be in an overall healthy condition, physicians must be aware that an underlying immunodeficiency might be present. 6 A brief summary of such potentially underlying immunodeficiencies is given in Table 1.…”

Section: Discussionmentioning

confidence: 72%

“…6 In children suffering from EG, presenting with frequent and/or atypical infectious episodes as in the present case, but also when they appear to be in an overall healthy condition, physicians must be aware that an underlying immunodeficiency might be present. 6 A brief summary of such potentially underlying immunodeficiencies is given in Table 1. In the workup, apart from a baseline full blood count and peripheral blood smear, repeated blood counts may be necessary for several weeks, even months, to identify underlying haematological Juvenile ecthyma gangrenosum abnormalities, including variants of neutropenia such as chronic, cyclic and transient neutropenia, the latter most commonly reported in association with EG.…”

Section: Discussionmentioning

confidence: 72%

“…Pseudomonas sepsis), whereas solitary lesions are more often the result of direct inoculation of the skin. 6 However, both solitary and multiple EG lesions, as the sole result of a primary infection limited to the skin, without concomitant sepsis, or related to an only transient bacteraemia, may occur. 5 Our present review of the literature shows that in 43 out of 72 (59.7%) previously healthy children diagnosed with EG sepsis could be documented, which is in accordance with findings from a large, recent review of patients of all ages affected by EG.…”

Section: Discussionmentioning

confidence: 99%

“…4 Children with an underlying bacterial sepsis present with weakness (100%), fever (90%), anorexia (100%), diarrhoea (58-72%) and/or tachycardia (100%). 6 Risk factors for (super)infection of the skin with P. aeruginosa 11 include pre-existent viral infections, a weak mechanical skin barrier and an impaired cellular and/or humoral immunity. 3,7 Especially neutrophils, important for the host defence against bacterial infections, such as P. aeruginosa, are a vital part of the cellular host defence.…”

Section: Discussionmentioning

confidence: 99%

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Juvenile ecthyma gangrenosum caused by Pseudomonas aeruginosa revealing an underlying neutropenia: case report and review of the literature

Wuyts

Wojciechowski

Maes

et al. 2019

Acad Dermatol Venereol

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Background Ecthyma gangrenosum (EG) is characterized by the occurrence of erythematous, violaceous or haemorrhagic macules and/or vesicles, often evolving into necrotic ulcers, with a central grey-black eschar. It is a rare skin condition, usually occurring in immunocompromised patients suffering from bacterial sepsis caused by Pseudomonas aeruginosa. However, seemingly healthy children have been diagnosed with this skin disease as well.Objectives We report the workup of a case of vulvar EG caused by P. aeruginosa in a toddler, which led to a diagnosis of an underlying neutropenia. Moreover, we provide a brief literature review on those cases of EG where an underlying primary immunodeficiency, neutropenia in particular, was eventually diagnosed.Methods A one-and-a-half-year-old girl presented with a history of recurrent (respiratory) infections and the sporadic occurrence of purpuric, vulvar ulcers. Workup consisted of microbiological and haematological investigations, including repeated blood analyses.Results Bacterial swabs from the vulvar ulcers showed the growth of P. aeruginosa. No concomitant sepsis was present, but laboratory investigations pointed towards a cyclic neutropenia, coinciding with the occurrence of the EG lesions. Topical gentamicin ointment allowed the skin lesions to heal faster. Following the administration of granulocyte colony-stimulating factor (G-CSF), the girl experienced less infections in general and had no recurrence of EG lesions in particular. Treatment with G-CSF could eventually be stopped, and the neutropenia, ultimately transient in nature, completely resolved. Conclusion Children presenting with (anogenital) EG should always alert a physician to consider a potentially underlying immunodeficiency, neutropenia in particular.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Juvenile ecthyma gangrenosum caused by Pseudomonas aeruginosa revealing an underlying neutropenia: case report and review of the literature

Wuyts

Wojciechowski

Maes

et al. 2019

Acad Dermatol Venereol

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“…[9,12] It is described as an uncommon vasculitis, affecting the adventitia and media of blood vessels and caused from either hematogenous seeding of a pathogen, or direct inoculation through the skin. [1,13,14] …”

Section: Discussionmentioning

confidence: 99%

Ecthyma gangrenosum, a skin manifestation of Pseudomonas aeruginosa sepsis in a previously healthy child

et al. 2017

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Rationale:Ecthyma gangrenosum (Eg) is a necrotic lesion that is mostly seen in immunocompromised patients. It reflects a severe sepsis, possibly caused by Pseudomonas aeruginosa (Pa).Patient concerns:A healthy 3-year-old girl admitted to the Pediatric Emergency Department presented a sepsis-associated purpura with neurological and respiratory distress.Interventions:An empiric antibiotherapy (anti-meningococcal) was prescribed.Diagnoses:Forty-eight hours after admission, blood and wound cultures were positive for Pa. As a result, the decision was made to change the antibiotic therapy.Unfortunately, on day 3, the patient died. Exhaustive immunologic tests are presently being carried out.Outcomes:Eg caused by Pa is uncommon in healthy children, and purpura sepsis is usually caused by Neisseria meningitides infection.Lessons:Eg should be recognized rapidly so that the appropriate treatment can be prescribed as quickly as possible.

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Cutaneous Infections in Immunocompromised Children

Weinstein¹,

Ott²,

Hoeger³

2019

Harper's Textbook of Pediatric Dermatology

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Ecthyma gangrenosum: A manifestation of community-acquired Pseudomonas aeruginosa septicemia in three infants

Cited by 23 publications

References 16 publications

Juvenile ecthyma gangrenosum caused by Pseudomonas aeruginosa revealing an underlying neutropenia: case report and review of the literature

Juvenile ecthyma gangrenosum caused by Pseudomonas aeruginosa revealing an underlying neutropenia: case report and review of the literature

Ecthyma gangrenosum, a skin manifestation of Pseudomonas aeruginosa sepsis in a previously healthy child

Cutaneous Infections in Immunocompromised Children

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