Ecthyma gangrenosum in an infant with neutropenia

Kikuchi, Nanae; Nakao, Hiro; Matsumoto, Yukio; Yoshida, Kazue; Okai, Masashi; Kawai, Toshinao; Kubota, Minoru; Ishiguro, Akira

doi:10.1007/s12185-020-03037-y

Cited by 2 publications

(3 citation statements)

References 2 publications

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“…6 There are scant reports describing the occurrence of EG in oncohematologic patients, mainly as case reports or small case series. [7][8][9][10][11][12][13][14][15][16] We report the results of a large multicenter pediatric retrospective collection of 38 cases of proven EG diagnosed between 2009 and 2019 in children with hematologic disease and cancer. The aim is to describe the clinical picture and characteristics of EG, to early recognize and diagnose it, since timely treatment influences the outcome of this infection.…”

Section: Introductionmentioning

confidence: 99%

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

Muggeo¹,

Zama

Decembrino

et al. 2022

Pediatric Infectious Disease Journal

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Background: To depict ecthyma gangrenosum (EG) clinical presentation and evolution in a large multicenter pediatric retrospective collection of children with malignancies or bone marrow failure syndromes, to facilitate early diagnosis. Methods: EG episodes diagnosed in the period 2009-2019 were identified by a retrospective review of clinical charts at centers belonging to the Italian Pediatric Hematology Oncology Association. Results: Thirty-eight cases of EG occurring in children (male/female 16/22; median age 5.2 years) with hematologic malignancy (29), allogeneic stem cell transplantation (2) or relapsed/refractory solid tumor (3) were collected. The involved sites were: perineal region (19), limbs (10), trunk (6), head and the iliac crest (3). Bacteremia was present in 22 patients. Overall, the germs isolated were Pseudomonas aeruginosa (30), Stenotrophomonas maltophilia (3) and Escherichia coli (1); 31% of them were multidrugresistant. All patients received antibacterial treatment, while surgery was performed in 24 patients (63.1%). Predisposing underlying conditions for EG were severe neutropenia (97.3%), corticosteroid treatment (71%) and iatrogenic diabetes (23.7%). All patients recovered, but EG recurred in 5 patients. Nine patients (24%) showed sequelae (deep scars, with muscle atrophy in 2). Four patients (10.5%) died, 1 due to relapse of EG with Carbapenem-resistant Enterobacteriaceae co-infection and 3 due to the progression of the underlying disease. Conclusions: EG requires early recognition and a proper and timely treatment to obtain the recovery and to avoid larger necrotic lesions, eventually evolving in scarring sequelae.

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Section: Introductionmentioning

confidence: 99%

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

Muggeo¹,

Zama

Decembrino

et al. 2022

Pediatric Infectious Disease Journal

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“…4 Department of Pathology, St. Luke's International Hospital, Tokyo, Japan. 5 Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan.…”

Section: Abbreviationsmentioning

confidence: 99%

“…EG initially manifests as macular erythematous lesions that later become hemorrhagic and transform into tender erythematous areas with necrotic centers. Pseudomonas aeruginosa has been reported to be responsible for 70–90% of EG [ 4 , 5 ], and the remaining cases are due to other microorganisms such as Aeromonas hydrophila [ 6 ] and Fusarium oxysporum [ 7 ]. Although E. dermatitidis is also known to cause cutaneous infections, it has not been reported as a causative agent of EG.…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary management of disseminated Exophiala dermatitidis mycosis in an infant with mixed phenotype acute leukemia: a case report

et al. 2022

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Background Exophiala dermatitidis is a dematiaceous fungus isolated from various environmental sources. Systemic E. dermatitidis infections can lead to fatal outcomes, and treatment has not yet been standardized. Although E. dermatitidis is also known to cause cutaneous infection, it has not been previously reported to appear as ecthyma gangrenosum (EG), an uncommon cutaneous lesion in neutropenic patients that is mainly caused by Pseudomonas aeruginosa. Case presentation A 2-month-old male infant with mixed-phenotype acute leukemia presented with prolonged fever unresponsive to antibacterial and antifungal agents during myelosuppression due to remission induction therapy. He also presented with skin lesions on the left wrist and left lower quadrant of the abdomen. The abdominal lesion gradually turned black and necrotic, which was consistent with the findings of the EG. E. dermatitidis was isolated from the blood, stool, wrist skin, and endotracheal aspirate. During hematopoietic recovery, consolidation in both lungs was evident. Multiagent antifungal treatment failed to eliminate E. dermatitidis from blood. In order to salvage the central venous catheter, ethanol lock therapy (ELT) was adopted, following which the blood culture became negative. The abdominal lesion that evolved as a necrotic mass connecting the small intestine and subcutaneous tissue adjacent to the skin was surgically resected. After these interventions, the general condition improved. Conclusion Disseminated E. dermatitidis mycosis in the neutropenic infant was successfully managed with a multidisciplinary treatment consisting of multiagent antifungal treatment, ELT, and surgery.

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Ecthyma gangrenosum in an infant with neutropenia

Cited by 2 publications

References 2 publications

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

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

Multidisciplinary management of disseminated Exophiala dermatitidis mycosis in an infant with mixed phenotype acute leukemia: a case report

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