Ecthyma gangrenosum in a previously healthy pediatric patient and associated facial paralysis and persistent hyperplastic primary vitreous

Abstract

SummaryBackground:Ecthyma gangrenosum is an infective lesion of the skin and mucosal membranes. It is most commonly caused by Pseudomonas aeruginosa, and the most important risk factors are malignancy and neutropenia. However, it has rarely been reported in children who were previously healthy. Persistent hyperplastic primary vitreous has been described as the persistence of the fetal hyaloid vascular system. Acute otitis media with facial paralysis is an infrequent association.Case Report:We report the case of a 5-month-old boy hospitalized because of fever, otorrhea and necrosis on his body. He had peripheral facial paralysis on the same side as otorrhea. Leukocoria was determined in the right eye. He had many gangrenous ulcers on the extremities and body.Conclusions:We present a previously healthy pediatric patient diagnosed with persistent hyperplastic primary vitreous, ecthyma gangrenosum (by the septicemia of P. aeruginosa), and peripheric facial paralysis (a complication of acute otitis media), admitted to hospital.

Ecthyma Gangrenosum in Children With Cancer: Diagnosis at a Glance: A Retrospective Study From the Infection Working Group of Italian Pediatric Hematology Oncology Association

“…Neutropenia has been reported as the most frequent risk factor for EG in different reports, 1,3,4 while corticosteroid treatment is known to play a role abrogating host defenses against bacteria. 18,19 In addition, hyperglycemia influences the risk of infection in hematologic malignancies.…”

“…21 The skin and gut dysbiosis, the mucositis and epithelial damage, consequence of the disease treatment, represent an open window for the access and spreading of pathogens. 4,6 Moreover, the endothelial damage likely due to chemotherapy 22 might be a facilitating risk factor for the development of EG, which starts typically with microvessel lesion and necrotizing vasculitis caused by bacteria, leading to perivascular invasion and ischemic necrosis of the surrounding tissue. EG is a septic vasculitis in which microorganisms may be demonstrated within the vessel wall and may occlude the vessels lumina.…”

“…Ecthyma gangrenosum (EG) is a relatively uncommon cutaneous infection that mostly occurs in individuals with immunosuppression due to different underlying diseases including hematologic disorders, malignancies, lymphoproliferative disorders and autoimmune diseases. 1 However, it has also been reported among previously healthy individuals, [2][3][4] both adults and children. Pseudomonas aeruginosa is the most common cause of EG, with or without bacteremia, although it is also known to be caused by a variety of pathogens, including different bacteria, fungi and viruses.…”

Ectima gangrenoso en pacientes pediátricos hematooncológicos, infección oportunista. Revisión de casos clínicos en el Centro Médico Nacional 20 de Noviembre

“…La neutropenia persistente en estos pacientes, además de ser factor de riesgo, es de mal pronóstico, incluso en casos en los que no tienen bacteriemia. [8][9][10] En la fisiopatogenia el EG se separa en dos formas clínicas (séptico y no séptico). El EG séptico es más común, en el cual el agente etiológico se propaga por vía hematógena a los capilares e invaden la adventicia y capa media de las arterias y venas.…”

Ecthyma gangrenosum: fatal form of pseudomonas aeruginosa infection in an eight-month-old infant

“…Эмпирическая антимикробная терапия обычно начинается с антипсевдомонадных -лактамов и корректируется после получения чувствительности бактериальной культуры [8][9][10]. Описанные комбинации антибактериальных препаратов, позволяющие добиться выздоровления больных включали: цефтазидим + амикацин или ципрофлоксацин, меропенем + амикацин или ципрофлоксацин, пиперациллин/тaзобактам + амикацин.…”